Healthcare Provider Details

I. General information

NPI: 1710043039
Provider Name (Legal Business Name): GOLDEN GATE PEDIATRICS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 CALIFORNIA ST
SAN FRANCISCO CA
94118-1701
US

IV. Provider business mailing address

3641 CALIFORNIA ST
SAN FRANCISCO CA
94118-1701
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0888
  • Fax: 415-752-5391
Mailing address:
  • Phone: 415-668-0888
  • Fax: 415-752-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EILEEN AICARDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-668-0888