Active NPI
Abigail Rebecca Bourgon, MD
- Pediatrics Physician
- Redwood City, CA
National Provider Identifier
1770845083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A106944
- Practice address
- 345 Convention Way
Suite D1
Redwood City, CA 94063-1444 - Phone
- (650) 306-3900
- NPI assigned
- Jun 12, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A106944 | CA | Primary |
Addresses
Primary practice location
345 Convention Way
Suite D1
Redwood City, CA 94063-1444
Mailing address
345 Convention Way
Suite D1
Redwood City, CA 94063-1444
Phone (650) 306-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A106944 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1770845083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 CONVENTION WAY",
"address_2": "SUITE D1",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940631444",
"telephone_number": "650-306-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 CONVENTION WAY",
"address_2": "SUITE D1",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940631444",
"telephone_number": "650-306-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGON",
"first_name": "ABIGAIL",
"middle_name": "REBECCA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-12",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A106944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.