Individual
GAUTAM NAGENDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4773
Mailing address
11175 CAMPUS STREET COLEMAN PAVILION CP -A1120, LOMA LINDA, CA 92350-0001
(909) 558-4773
(909) 558-0479
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
A155780
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/31/2015
Last updated
10/05/2021
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