Provider Demographics
NPI:1689036824
Name:GWALANI, JAIMISH
Entity type:Individual
Prefix:
First Name:JAIMISH
Middle Name:
Last Name:GWALANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38437 MISSION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4318
Mailing Address - Country:US
Mailing Address - Phone:510-806-1425
Mailing Address - Fax:510-768-8758
Practice Address - Street 1:38437 MISSION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4318
Practice Address - Country:US
Practice Address - Phone:510-806-1425
Practice Address - Fax:510-768-8758
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151701208VP0014X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine