1457366833 NPI number — GLORIA G. CARREON, MD, PROFESSIONAL CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457366833 NPI number — GLORIA G. CARREON, MD, PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLORIA G. CARREON, MD, PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457366833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94537-7390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-745-6532
Provider Business Mailing Address Fax Number:
510-797-4059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 MOWRY AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-797-1554
Provider Business Practice Location Address Fax Number:
510-797-1555
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARREON
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
GAETA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-797-1554

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A063278 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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