Healthcare Provider Details

I. General information

NPI: 1528230679
Provider Name (Legal Business Name): GABRIEL HERSCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39141 CIVIC CENTER DR STE # 335
FREMONT CA
94538-5818
US

IV. Provider business mailing address

1611 W MARCH LN
STOCKTON CA
95207-6401
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1420
  • Fax: 510-791-2874
Mailing address:
  • Phone: 209-226-4300
  • Fax: 209-227-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA98129
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA98129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: