Healthcare Provider Details

I. General information

NPI: 1386398311
Provider Name (Legal Business Name): ERIC GORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 TAYLOR RD
NEWCASTLE CA
95658-9778
US

IV. Provider business mailing address

991 TAYLOR RD
NEWCASTLE CA
95658-9778
US

V. Phone/Fax

Practice location:
  • Phone: 650-224-1686
  • Fax:
Mailing address:
  • Phone: 650-224-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: