Provider Demographics
NPI:1811216765
Name:BASSIRPOUR, GILLIAN GOLDBERG (MD)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:GOLDBERG
Last Name:BASSIRPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:MICHELE
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 JOURNEY STE 201
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3373
Mailing Address - Country:US
Mailing Address - Phone:949-287-4900
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNEY STE 201
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3373
Practice Address - Country:US
Practice Address - Phone:949-287-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC174521207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy