Provider Demographics
NPI:1629298153
Name:CURBELO, GUSTAVO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ANTONIO
Last Name:CURBELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:2240 GLADSTONE DRIVE
Practice Address - Street 2:STE 4
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:925-431-2100
Practice Address - Fax:925-431-1234
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1976OtherFQHC MEDICARE PART A
CAHAP70816FOtherFPACT
CAZZZ21677ZOtherFQHC MEDICARE PART B
CAFHC70816FMedicaid