Provider Demographics
NPI:1164866182
Name:GAIROLA, CHETAN KRISHNA (DO)
Entity Type:Individual
Prefix:MR
First Name:CHETAN
Middle Name:KRISHNA
Last Name:GAIROLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:860-533-6559
Mailing Address - Fax:860-533-6571
Practice Address - Street 1:14011 PARK AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2413
Practice Address - Country:US
Practice Address - Phone:888-750-0036
Practice Address - Fax:860-533-6571
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A-14483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program