Healthcare Provider Details

I. General information

NPI: 1104410885
Provider Name (Legal Business Name): IRINA GORDON RN MSN CWOCN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 DIVISADERO ST
SAN FRANCISCO CA
94115-3012
US

IV. Provider business mailing address

7 OAKMONT CT
SAN RAFAEL CA
94901-1235
US

V. Phone/Fax

Practice location:
  • Phone: 415-287-0859
  • Fax: 415-599-8456
Mailing address:
  • Phone: 415-867-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: