1003070541 NPI number — DR. CHRISTINE DANIELLE GOREY D.O

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 1003070541 NPI number — DR. CHRISTINE DANIELLE GOREY D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOREY
Provider First Name:
CHRISTINE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

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:
1003070541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 CLUB DR
Provider Second Line Business Mailing Address:
MARE ISLAND
Provider Business Mailing Address City Name:
VALLEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94592-1187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-330-3027
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 TUOLUMNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94590-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-330-3027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101017946 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 20A 12135 , 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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