Provider Demographics
NPI:1326421884
Name:FULGENCIO, GRETCHEN SANTOS (RN, NP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:SANTOS
Last Name:FULGENCIO
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:TORRIJOS
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:3100 SAN PABLO AVE.
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702
Mailing Address - Country:US
Mailing Address - Phone:415-476-3369
Mailing Address - Fax:510-985-5202
Practice Address - Street 1:3100 SAN PABLO AVE.
Practice Address - Street 2:SUITE 430
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702
Practice Address - Country:US
Practice Address - Phone:415-476-3369
Practice Address - Fax:510-985-5202
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA676689163WX0200X
CA22811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology