Healthcare Provider Details

I. General information

NPI: 1740920784
Provider Name (Legal Business Name): LUIS REY GASCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROADWAY ST FL 2
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

450 BROADWAY ST FL 2
REDWOOD CITY CA
94063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6601
  • Fax:
Mailing address:
  • Phone: 650-723-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74646
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA202105
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32551
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: