Healthcare Provider Details

I. General information

NPI: 1447483532
Provider Name (Legal Business Name): GMS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 W TAYLOR ST STE 1
SAN JOSE CA
95126-1815
US

IV. Provider business mailing address

1413 1/2 W KENNETH RD # 7
GLENDALE CA
91201-1478
US

V. Phone/Fax

Practice location:
  • Phone: 408-315-1051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG39449
License Number StateCA

VIII. Authorized Official

Name: MAHAMMED IBRAHIM
Title or Position: PRESIDENT
Credential:
Phone: 408-315-1051