Healthcare Provider Details

I. General information

NPI: 1710810809
Provider Name (Legal Business Name): MAXINE ALEXANDRA GASPAR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE 100
FREMONT CA
94538-5823
US

IV. Provider business mailing address

400 SANTA CLARA AVE APT 33
OAKLAND CA
94610-1970
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-0961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number95426444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: