Healthcare Provider Details

I. General information

NPI: 1316242878
Provider Name (Legal Business Name): TINA GABBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FIFER AVE SUITE 200
CORTE MADERA CA
94925-1134
US

IV. Provider business mailing address

2 FIFER AVE SUITE 200
CORTE MADERA CA
94925-1134
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-3255
  • Fax: 415-381-3255
Mailing address:
  • Phone: 415-381-3255
  • Fax: 415-381-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberG058385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: