Provider Demographics
NPI:1053096537
Name:ROHANITAZANGI, GITA
Entity type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:ROHANITAZANGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 DAVID AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3835
Mailing Address - Country:US
Mailing Address - Phone:925-812-4128
Mailing Address - Fax:
Practice Address - Street 1:1253 DAVID AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3835
Practice Address - Country:US
Practice Address - Phone:925-812-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice