MEDICARE: MAXINE ALEXANDRA GASPAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	95426444	CA

General Provider Information

NPI Number	:	1710810809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE ALEXANDRA GASPAR

Provider Business Mailing Address
First Line	:	400 SANTA CLARA AVE APT 33
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39141 CIVIC CENTER DR STE 100
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-5823
Country	:	US
Telephone Number	:	510-490-0961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ MAXINE ALEXANDRA GASPAR ” Practice Location

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