Provider Demographics
NPI:1376204669
Name:GAURAV, JIVITESH
Entity Type:Individual
Prefix:
First Name:JIVITESH
Middle Name:
Last Name:GAURAV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 W FOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4689
Mailing Address - Country:US
Mailing Address - Phone:201-936-9345
Mailing Address - Fax:
Practice Address - Street 1:2749 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5110
Practice Address - Country:US
Practice Address - Phone:718-277-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program