Provider Demographics
NPI:1407042161
Name:H.P. GULESSERIAN, MD., INC.
Entity Type:Organization
Organization Name:H.P. GULESSERIAN, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HRAIR
Authorized Official - Middle Name:PUZANT
Authorized Official - Last Name:GULESSERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-578-5831
Mailing Address - Street 1:393 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1652
Mailing Address - Country:US
Mailing Address - Phone:408-578-5831
Mailing Address - Fax:408-578-6076
Practice Address - Street 1:393 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1652
Practice Address - Country:US
Practice Address - Phone:408-578-5831
Practice Address - Fax:408-578-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA243412086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243410Medicaid
CA00A243410Medicaid
CA00A243410Medicare PIN