Provider Demographics
NPI:1598782468
Name:GOFMAN, INESSA (MD)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:GOFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-600-2403
Mailing Address - Fax:415-369-1294
Practice Address - Street 1:3838 CALIFORNIA ST RM 510
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1507
Practice Address - Country:US
Practice Address - Phone:415-600-2403
Practice Address - Fax:415-369-1294
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88685208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics