Individual
MRS. DANIELLE ALEXIS GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
705 PALM AVE, IMPERIAL BEACH, CA 91932-1229
(619) 423-3774
Mailing address
1244 EL CORTEZ CT, CHULA VISTA, CA 91910-8186
(904) 631-2880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
95010963
CA
363LF0000X
Family Nurse Practitioner
Primary
NP95010963
CA
Other
Enumeration date
01/30/2019
Last updated
05/12/2020
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