Healthcare Provider Details

I. General information

NPI: 1053486787
Provider Name (Legal Business Name): KAREN GUDIKSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 MIRA VISTA DR
CASTRO VALLEY CA
94546-1033
US

IV. Provider business mailing address

4721 MIRA VISTA DR
CASTRO VALLEY CA
94546-1033
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-0466
  • Fax:
Mailing address:
  • Phone: 510-886-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301082540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: