Basic Information
| Provider Information | |||||||||
| NPI: | 1629298153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURBELO | ||||||||
| FirstName: | GUSTAVO | ||||||||
| MiddleName: | ANTONIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 FRUITVALE AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354000 | ||||||||
| FaxNumber: | 5105354128 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 GLADSTONE DRIVE | ||||||||
| Address2: | STE 4 | ||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312100 | ||||||||
| FaxNumber: | 9254311234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A98595 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 55-1976 | 01 | CA | FQHC MEDICARE PART A | OTHER | HAP70816F | 01 | CA | FPACT | OTHER | ZZZ21677Z | 01 | CA | FQHC MEDICARE PART B | OTHER | FHC70816F | 05 | CA | MEDICAID |