Basic Information
| Provider Information | |||||||||
| NPI: | 1548322795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOURGUIGNON | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 W MACARTHUR BLVD | ||||||||
| Address2: | KAISER GENETICS | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107526755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 W MACARTHUR BLVD | ||||||||
| Address2: | KAISER GENETICS | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107526755 | ||||||||
| FaxNumber: | 5107526754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | GC000080 | CA | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.