Healthcare Provider Details

I. General information

NPI: 1023071404
Provider Name (Legal Business Name): LOUIS EDWIN GIRLING JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 EMPEY WAY
SAN JOSE CA
95128-4705
US

IV. Provider business mailing address

639 EDINBURGH ST
SAN FRANCISCO CA
94112-3532
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-6230
  • Fax:
Mailing address:
  • Phone: 415-586-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA47959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: