Healthcare Provider Details

I. General information

NPI: 1447271085
Provider Name (Legal Business Name): PATRICIA S. GORDON MD PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD SUITE 160
BEVERLY HILLS CA
90211-2142
US

IV. Provider business mailing address

150 N ROBERTSON BLVD SUITE 160
BEVERLY HILLS CA
90211-2142
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-6770
  • Fax: 310-659-5460
Mailing address:
  • Phone: 310-659-6770
  • Fax: 310-659-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberG53353
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICIA SCHREIBER GORDON
Title or Position: PRESIDENT
Credential: MD
Phone: 310-659-6770