Provider Demographics
NPI:1992715155
Name:GONDHA, CHETAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:
Last Name:GONDHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N. BRENT STREET
Mailing Address - Street 2:SUITE 404
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-641-6525
Mailing Address - Fax:805-641-6530
Practice Address - Street 1:168 N. BRENT STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-641-6525
Practice Address - Fax:805-641-6530
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057628207R00000X
CAA113015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine