Provider Demographics
NPI:1902481765
Name:GOLDEN GATE PERFUSION, INC.
Entity Type:Organization
Organization Name:GOLDEN GATE PERFUSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PERFUSIONIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:415-341-6260
Mailing Address - Street 1:138 ELSIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5149
Mailing Address - Country:US
Mailing Address - Phone:415-566-6808
Mailing Address - Fax:415-551-1919
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:451-353-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty