Healthcare Provider Details

I. General information

NPI: 1902481765
Provider Name (Legal Business Name): GOLDEN GATE PERFUSION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

138 ELSIE ST
SAN FRANCISCO CA
94110-5149
US

V. Phone/Fax

Practice location:
  • Phone: 451-353-1357
  • Fax:
Mailing address:
  • Phone: 415-566-6808
  • Fax: 415-551-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name: LAUREL MICHELLE CHAMBLESS
Title or Position: CHIEF PERFUSIONIST
Credential: CCP
Phone: 415-341-6260