Healthcare Provider Details

I. General information

NPI: 1497731921
Provider Name (Legal Business Name): GRETCHEN AW GOODING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN FRANCISCO VAMC, 4150 CLEMENT STREET DEPT OF RADIOLOGY, (114) RM.2A 173
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

8 OVERHILL RD
MILL VALLEY CA
94941-1378
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-750-6944
Mailing address:
  • Phone: 415-388-1766
  • Fax: 415-388-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberC 30376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: