Healthcare Provider Details

I. General information

NPI: 1528073996
Provider Name (Legal Business Name): GUIDO J GORES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE ST STE 125
SAN FRANCISCO CA
94109-4832
US

IV. Provider business mailing address

909 HYDE ST STE 125
SAN FRANCISCO CA
94109-4832
US

V. Phone/Fax

Practice location:
  • Phone: 415-771-4366
  • Fax: 415-771-6412
Mailing address:
  • Phone: 415-771-4366
  • Fax: 415-771-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG612540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: