Healthcare Provider Details

I. General information

NPI: 1598059586
Provider Name (Legal Business Name): NICOLE LYNN GERGEN VILLAPIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE LYNN GERGEN MD

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 OWENS DR BLDG E 2ND FLOOR
PLEASANTON CA
94588-3900
US

IV. Provider business mailing address

5820 OWENS DR BLDG E2ND
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 925-737-3785
  • Fax:
Mailing address:
  • Phone: 925-737-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02344
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107537
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107537
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP02344
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC196387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: