Provider Demographics
NPI:1679645485
Name:SHIU, GERTRUDE (MD)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:
Last Name:SHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GERTRUDE
Other - Middle Name:
Other - Last Name:SHIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2948
Mailing Address - Fax:916-858-7065
Practice Address - Street 1:3000 Q STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-0000
Practice Address - Country:US
Practice Address - Phone:916-733-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60012207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A600120Medicaid
CA00A600120Medicaid
00A600120Medicare ID - Type Unspecified