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Organization
GAURAV DATTA MD INC
Active
Organization
GAURAV DATTA MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAURAV DATTA MD (OWNER)
(414) 336-8677
Entity
Organization
Contact information
Practice address
7510 FORTALEZA AVE, ELK GROVE, CA 95757-1769
(414) 336-8677
(925) 954-6958
Mailing address
7510 FORTALEZA AVE, ELK GROVE, CA 95757-1769
(414) 336-8677
(925) 954-6958
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
282N00000X
General Acute Care Hospital
—
—
Other
Enumeration date
06/17/2020
Last updated
01/13/2023
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