Basic Information
| Provider Information | |||||||||
| NPI: | 1881795763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLADSTEIN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | BIALEK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BIALEK | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1381 UNIVERSITY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HEALDSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954483314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073852295 | ||||||||
| FaxNumber: | 7074311427 | ||||||||
| Practice Location | |||||||||
| Address1: | 8465 OLD REDWOOD HWY, #320 | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954929244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073852295 | ||||||||
| FaxNumber: | 7074311427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | G060217 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 261QF0400X | 60217 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QF0400X | 21954 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.