Individual
ALEXANDER LEONARD GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
2716 FREEDOM BLVD, FREEDOM, CA 95019
(831) 688-6293
Mailing address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
163W00000X
Registered Nurse
202206489RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
11/19/2015
Last updated
05/24/2023
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