Provider Demographics
NPI:1457366833
Name:GLORIA G. CARREON, MD, PROFESSIONAL CORP
Entity Type:Organization
Organization Name:GLORIA G. CARREON, MD, PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:GAETA
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-797-1554
Mailing Address - Street 1:PO BOX 7390
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-7390
Mailing Address - Country:US
Mailing Address - Phone:510-745-6532
Mailing Address - Fax:510-797-4059
Practice Address - Street 1:1900 MOWRY AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-797-1554
Practice Address - Fax:510-797-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty