Provider Demographics
NPI:1689228462
Name:GAMEDAY SPORTS MEDICINE ACADEMY
Entity Type:Organization
Organization Name:GAMEDAY SPORTS MEDICINE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:RAMAN
Authorized Official - Last Name:DEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-327-2101
Mailing Address - Street 1:2901 SILLECT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6373
Mailing Address - Country:US
Mailing Address - Phone:661-706-9444
Mailing Address - Fax:661-327-2554
Practice Address - Street 1:3101 GILMORE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6342
Practice Address - Country:US
Practice Address - Phone:661-327-2101
Practice Address - Fax:661-327-2554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA INSTITUTE OF COSMETIC AND RECONSTRUCTIVE SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports MedicineGroup - Multi-Specialty