Provider Demographics
NPI:1407652480
Name:GORDON, MARGARET LOUISE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LOUISE
Last Name:GORDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:LOUISE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1302 N PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2521
Mailing Address - Country:US
Mailing Address - Phone:714-853-9275
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4469
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-475-5575
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician