Healthcare Provider Details

I. General information

NPI: 1306327507
Provider Name (Legal Business Name): RACHAEL GORDON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 SAN IGNACIO AVE STE A
SAN JOSE CA
95119-1363
US

IV. Provider business mailing address

1104 E JACKSON ST
MEDFORD OR
97504-7029
US

V. Phone/Fax

Practice location:
  • Phone: 541-313-3617
  • Fax: 769-235-0747
Mailing address:
  • Phone: 541-313-3617
  • Fax: 769-235-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95042892
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202108915NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: