Provider Demographics
NPI:1164598058
Name:PLANNED PARENTHOOD GOLDEN GATE
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD GOLDEN GATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-574-5823
Mailing Address - Street 1:2211 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1814
Mailing Address - Country:US
Mailing Address - Phone:650-574-5823
Mailing Address - Fax:650-377-0812
Practice Address - Street 1:1370 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2934
Practice Address - Country:US
Practice Address - Phone:650-574-5823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70409GMedicaid
CAZZZ13813ZMedicare ID - Type Unspecified