Healthcare Provider Details

I. General information

NPI: 1013826494
Provider Name (Legal Business Name): AMY LOUREE GAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19341 BEAR VALLEY RD STE 105
APPLE VALLEY CA
92308-5152
US

IV. Provider business mailing address

19341 BEAR VALLEY RD STE 105
APPLE VALLEY CA
92308-5152
US

V. Phone/Fax

Practice location:
  • Phone: 760-490-0592
  • Fax: 760-247-6559
Mailing address:
  • Phone: 760-490-0592
  • Fax: 760-247-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95204288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: