Healthcare Provider Details

I. General information

NPI: 1962789966
Provider Name (Legal Business Name): POST STREET OCCUPATIONAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FIFER AVE SUITE 130
CORTE MADERA CA
94925-1134
US

IV. Provider business mailing address

2299 POST ST SUITE 103
SAN FRANCISCO CA
94115-3441
US

V. Phone/Fax

Practice location:
  • Phone: 415-945-1304
  • Fax:
Mailing address:
  • Phone: 415-923-0992
  • Fax: 415-923-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD GORDON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 415-923-0992