Healthcare Provider Details

I. General information

NPI: 1649006016
Provider Name (Legal Business Name): MONICA RENEE GORDON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

2521 MARINER RD
OAKLEY CA
94561-5031
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4000
  • Fax: 510-437-5173
Mailing address:
  • Phone: 510-298-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number556721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: