Provider Demographics
NPI:1497963896
Name:KASTURI, GOPI
Entity Type:Individual
Prefix:
First Name:GOPI
Middle Name:
Last Name:KASTURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GOPI
Other - Middle Name:
Other - Last Name:KASTURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 S SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-6434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1630 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3391
Practice Address - Country:US
Practice Address - Phone:559-256-5953
Practice Address - Fax:559-261-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107851208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation