Provider Demographics
NPI:1932776325
Name:SOWDA, GAUTAM
Entity Type:Individual
Prefix:
First Name:GAUTAM
Middle Name:
Last Name:SOWDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 HEDGECROFT PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2029
Mailing Address - Country:US
Mailing Address - Phone:408-772-4223
Mailing Address - Fax:
Practice Address - Street 1:3100 TELEGRAPH AVE STE 1000
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3285
Practice Address - Country:US
Practice Address - Phone:408-772-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program