Provider Demographics
NPI:1780977504
Name:GORDON, AMY E (MS LAC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3910
Mailing Address - Country:US
Mailing Address - Phone:415-405-6004
Mailing Address - Fax:
Practice Address - Street 1:3580 CALIFORNIA ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1717
Practice Address - Country:US
Practice Address - Phone:415-857-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist