Provider Demographics
NPI:1306388087
Name:GOPIKA GANGUPANTULA, MD, INC.
Entity Type:Organization
Organization Name:GOPIKA GANGUPANTULA, MD, INC.
Other - Org Name:VALLEY DIABETES & OBESITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGUPANTULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-497-4677
Mailing Address - Street 1:1213 COFFEE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4229
Mailing Address - Country:US
Mailing Address - Phone:209-497-4677
Mailing Address - Fax:209-300-7172
Practice Address - Street 1:1213 COFFEE RD STE D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4229
Practice Address - Country:US
Practice Address - Phone:209-497-4677
Practice Address - Fax:209-300-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty