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General NPI Number Information
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NPI Number | 1710810809
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Entity Type | Individual
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Provider Name | MAXINE ALEXANDRA GASPAR
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Gender |
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 39141 CIVIC CENTER DR STE 100
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City | FREMONT
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State | CA
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Zip | 94538-5823
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Country | US
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Telephone | 510-490-0961
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SANTA CLARA AVE APT 33
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City | OAKLAND
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State | CA
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Zip | 94610-1970
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 95426444
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License Number State | CA
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