Provider Demographics
NPI:1619234523
Name:GANDHI, PRATIK JAGDISH (DO)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:JAGDISH
Last Name:GANDHI
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 1:2488 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5508
Mailing Address - Country:US
Mailing Address - Phone:201-274-6326
Mailing Address - Fax:209-948-2665
Practice Address - Street 1:2488 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:201-274-6326
Practice Address - Fax:209-948-2665
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60647797208100000X
CA20A15756208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation