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General NPI Number Information
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NPI Number | 1457366833
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Entity Type | Organization
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Legal Business Name | GLORIA G. CARREON, MD, PROFESSIONAL CORP
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 1900 MOWRY AVE SUITE 202
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City | FREMONT
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State | CA
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Zip | 94538-1722
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Country | US
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Telephone | 510-797-1554
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Fax | 510-797-1555
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Provider Business Mailing Address
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Address Line | PO BOX 7390
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City | FREMONT
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State | CA
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Zip | 94537-7390
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Country | US
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Telephone | 510-745-6532
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Fax | 510-797-4059
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLORIA GAETA CARREON
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Credential | M.D.
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Telephone | 510-797-1554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A063278
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License Number State | CA
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