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General NPI Number Information
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NPI Number | 1083780712
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Entity Type | Individual
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Provider Name | CAMILLE GORDON
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/24/2019
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Provider Practice Location Address
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Address Line | 255 N WHITE RD STE 200
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City | SAN JOSE
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State | CA
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Zip | 95127-1966
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Country | US
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Telephone | 408-503-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E EL CAMINO REAL MEDICAL STAFF DEPT.
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2833
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Country | US
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Telephone | 408-739-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5214
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 54318
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License Number State | CA
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