Provider Demographics
NPI:1598213027
Name:AMITABH U GOSWAMI DO INC
Entity Type:Organization
Organization Name:AMITABH U GOSWAMI DO INC
Other - Org Name:CALIFORNIA PAIN CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMITABH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-478-4157
Mailing Address - Street 1:7255 N CEDAR AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-478-4757
Mailing Address - Fax:559-323-4143
Practice Address - Street 1:7255 N CEDAR AVE
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3831
Practice Address - Country:US
Practice Address - Phone:559-478-4757
Practice Address - Fax:559-323-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9044208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty