Provider Demographics
NPI:1578788071
Name:GOMES TINDLE, MARY LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:GOMES TINDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1332 CALIFORNIA ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4964
Mailing Address - Country:US
Mailing Address - Phone:415-474-9919
Mailing Address - Fax:
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:SUITE 322 DR JEROME GOLDSTEIN MD
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4822
Practice Address - Country:US
Practice Address - Phone:415-673-4600
Practice Address - Fax:415-673-9532
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant