Provider Demographics
NPI:1255042768
Name:GORDON, DANIEL (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 DAVIS CT APT 1806
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8000 MARINA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1887
Practice Address - Country:US
Practice Address - Phone:415-514-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019216363L00000X
CANP95019216363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner