Provider Demographics
NPI:1710224100
Name:GAUDREAU, PARYA (DO)
Entity Type:Individual
Prefix:MRS
First Name:PARYA
Middle Name:
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CAMBRIA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4616
Mailing Address - Country:US
Mailing Address - Phone:408-806-5411
Mailing Address - Fax:
Practice Address - Street 1:53 N SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5916
Practice Address - Country:US
Practice Address - Phone:408-399-8003
Practice Address - Fax:409-399-8004
Is Sole Proprietor?:No
Enumeration Date:2013-01-06
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist