Provider Demographics
NPI:1275679185
Name:GORDON, ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:
Last Name:GORDON
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 1:116 VIA FLOREADO
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1927
Mailing Address - Country:US
Mailing Address - Phone:925-934-4095
Mailing Address - Fax:925-254-7090
Practice Address - Street 1:116 VIA FLOREADO
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-1927
Practice Address - Country:US
Practice Address - Phone:925-934-4095
Practice Address - Fax:925-254-7090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG266232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry