Healthcare Provider Details

I. General information

NPI: 1669283164
Provider Name (Legal Business Name): BRYAN EUGENE GARDNER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

IV. Provider business mailing address

441 EL CAMINO REAL UNIT 4301
SAN CARLOS CA
94070-2472
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-496-2523
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95176408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: