Individual
DR. GOWTHAMY BALAKUMARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
301 N R ST, LOMPOC, CA 93436-5226
(805) 737-6400
(805) 737-6430
Mailing address
3676 JUPITER AVE, LOMPOC, CA 93436-1941
(805) 733-9515
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A67113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A671130
—
CA
01
—
A67113
MED LICENSE
CA
Enumeration date
08/05/2006
Last updated
03/14/2013
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