Provider Demographics
NPI:1699718833
Name:GASPAR, KATHY G (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:G
Last Name:GASPAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3822
Mailing Address - Country:US
Mailing Address - Phone:916-278-6027
Mailing Address - Fax:916-278-7359
Practice Address - Street 1:6000 J ST
Practice Address - Street 2:CSUS STUDENT HEALTH CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2605
Practice Address - Country:US
Practice Address - Phone:916-278-6464
Practice Address - Fax:916-278-7359
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG754YMedicare UPIN
H91261Medicare UPIN
CAZZZ02702ZMedicare PIN