Individual
MR. GABRIEL GORDON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
750 REDWOOD HWY STE 1204, STE 1204, MILL VALLEY, CA 94941-2483
(415) 384-4778
(415) 384-4779
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5325
GA
363AM0700X
Medical Physician Assistant
Primary
58405
CA
Other
Enumeration date
04/02/2008
Last updated
10/19/2020
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