Individual
DR. GAUTAM VANGIPURAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2619 E COLORADO BLVD STE 150, PASADENA, CA 91107-3747
(626) 793-4168
(626) 793-6256
Mailing address
1900 W GARVEY AVE S UNIT 335, WEST COVINA, CA 91790-2656
(626) 305-9100
(626) 305-9150
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
2019018140
MO
207WX0107X
Retina Specialist (Ophthalmology) Physician
2019018140
MO
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
C173301
CA
Other
Enumeration date
09/14/2015
Last updated
01/10/2022
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