Healthcare Provider Details

I. General information

NPI: 1598782468
Provider Name (Legal Business Name): INESSA GOFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CAMINO ALTO STE 103
MILL VALLEY CA
94941-2910
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-0918
  • Fax:
Mailing address:
  • Phone: 415-600-2403
  • Fax: 415-369-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA88685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: