Provider Demographics
NPI:1124367255
Name:GOPAKUMAR, UMA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:UMA
Middle Name:
Last Name:GOPAKUMAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 W GARY AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-2067
Mailing Address - Country:US
Mailing Address - Phone:480-668-5086
Mailing Address - Fax:480-396-2298
Practice Address - Street 1:5252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8022
Practice Address - Country:US
Practice Address - Phone:480-396-3222
Practice Address - Fax:480-396-2298
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ848580Medicaid