Provider Demographics
NPI:1952634834
Name:SIVARAMAN, GOWRI (MD)
Entity Type:Individual
Prefix:
First Name:GOWRI
Middle Name:
Last Name:SIVARAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11282 REDBUD CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2334
Mailing Address - Country:US
Mailing Address - Phone:858-675-2208
Mailing Address - Fax:
Practice Address - Street 1:11282 REDBUD CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2334
Practice Address - Country:US
Practice Address - Phone:858-675-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine