| Gazebo Medical Corporation, P.c. | |
|
142 Crescent Ave Portola Valley CA 94028-7821 | |
| (650) 714-2411 | |
| Not Available |
| Full Name | Gazebo Medical Corporation, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 142 Crescent Ave, Portola Valley, California |
| Authorized Official Name and Position | Norman Lance Downing (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6502605631 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gazebo Medical Corporation, P.c. 142 Crescent Ave Portola Valley CA 94028-7821 Ph: (650) 714-2411 | Gazebo Medical Corporation, P.c. 142 Crescent Ave Portola Valley CA 94028-7821 Ph: (650) 714-2411 |
| NPI Number | 1477121903 |
|---|---|
| Provider Enumeration Date | 06/11/2021 |
| Last Update Date | 12/13/2021 |
| Certification Date | 12/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477121903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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