Healthcare Provider Details

I. General information

NPI: 1750572020
Provider Name (Legal Business Name): L STEPHEN GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR SUITE 415
ARCADIA CA
91007-3462
US

IV. Provider business mailing address

301 W HUNTINGTON DR SUITE 415
ARCADIA CA
91007-3462
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-5552
  • Fax: 626-445-4411
Mailing address:
  • Phone: 626-445-5552
  • Fax: 626-445-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG124580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: