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Organization
RAVINDRA GAUTAM, M.D., INC.
Active
Organization
RAVINDRA GAUTAM, M.D., INC.
Active
Parent organization
RAVINDRA GAUTAM MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
RAVINDRA GAUTAM MD
Authorized official
RAVINDRA MOHARPAL GAUTAM (CEO)
(760) 256-1004
Entity
Organization
Contact information
Practice address
930 W MAIN ST, BARSTOW, CA 92311-2654
(760) 256-1004
(760) 256-1055
Mailing address
PO BOX 1519, BARSTOW, CA 92312-1519
(760) 256-1004
(760) 256-1055
Taxonomy
Speciality
Code
Description
License number
State
163WC3500X
Cardiac Rehabilitation Registered Nurse
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
261QR0404X
Cardiac Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/04/2006
Last updated
11/27/2024
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