Healthcare Provider Details

I. General information

NPI: 1831923812
Provider Name (Legal Business Name): GABRIELLE ANNE DUFORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 QUARRY RD FL 4MC5979
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

501 FOREST AVE APT 1004
PALO ALTO CA
94301-2615
US

V. Phone/Fax

Practice location:
  • Phone: 514-652-5420
  • Fax:
Mailing address:
  • Phone: 514-652-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA198780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: