Golden Gate Pediatrics - A Medical Corporation San Francisco Office - 1 Daniel Burnham Ct. 330C San Francisco CA 94109 415 668-0888 / 415 752-5391 - fax Mill Valley office - 61 Camino Alto 107 Mill Valley CA 94941 415 388-6303 / 415 388-7136 - fax Authorization for Disclosure of Patient Information Please provide all information requested or ....