Healthcare Provider Details

I. General information

NPI: 1124323811
Provider Name (Legal Business Name): DAVID LEON GORDON JR. M.S.S.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EMBARCADERO STE 303
OAKLAND CA
94606-5227
US

IV. Provider business mailing address

1900 EMBARCADERO STE 303
OAKLAND CA
94606-5227
US

V. Phone/Fax

Practice location:
  • Phone: 209-647-6200
  • Fax: 209-647-6210
Mailing address:
  • Phone: 209-647-6200
  • Fax: 209-647-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: