Provider Demographics
NPI:1245579655
Name:GOLDEN GATE PEDIATRICS, A MEDICAL CORP
Entity Type:Organization
Organization Name:GOLDEN GATE PEDIATRICS, A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-668-0888
Mailing Address - Street 1:ONE DANIEL BURNHAM COURT
Mailing Address - Street 2:#330C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-668-0888
Mailing Address - Fax:415-752-5391
Practice Address - Street 1:ONE DANIEL BURNHAM COURT
Practice Address - Street 2:#330C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-668-0888
Practice Address - Fax:415-752-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30886208000000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty