Healthcare Provider Details

I. General information

NPI: 1538081211
Provider Name (Legal Business Name): KESHIA MARICE ATES GANDIONCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 EASTMOOR AVE
DALY CITY CA
94015-2036
US

IV. Provider business mailing address

545 SYLVAN ST
DALY CITY CA
94014-2725
US

V. Phone/Fax

Practice location:
  • Phone: 650-501-7650
  • Fax:
Mailing address:
  • Phone: 650-501-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: