| Gopika Gangupantula, Md, Inc. | |
|
1213 Coffee Rd Ste D Modesto CA 95355-4229 | |
| (209) 497-4677 | |
| (209) 300-7172 |
| Full Name | Gopika Gangupantula, Md, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1213 Coffee Rd Ste D, Modesto, California |
| Authorized Official Name and Position | Sachin Gangupantula (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 2094974677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gopika Gangupantula, Md, Inc. 1213 Coffee Rd Ste D Modesto CA 95355-4229 Ph: (209) 497-4677 | Gopika Gangupantula, Md, Inc. 1213 Coffee Rd Ste D Modesto CA 95355-4229 Ph: (209) 497-4677 |
| NPI Number | 1306388087 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 02/28/2024 |
| Medicare PECOS PAC ID | 4284911322 |
|---|---|
| Medicare Enrollment ID | O20170427001892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306388087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A81025 (California) | Primary |
| Provider Name | Gopika Gangupantula |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245318138 PECOS PAC ID: 0749340354 Enrollment ID: I20081126000394 |
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