Healthcare Provider Details

I. General information

NPI: 1609430065
Provider Name (Legal Business Name): GILROY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 MONTEREY RD STE H
GILROY CA
95020-7200
US

IV. Provider business mailing address

2222 LAFAYETTE ST
SANTA CLARA CA
95050-2904
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-1544
  • Fax:
Mailing address:
  • Phone: 408-307-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD SIAO
Title or Position: PRESIDENT
Credential: MD
Phone: 408-206-0217