Healthcare Provider Details

I. General information

NPI: 1780662668
Provider Name (Legal Business Name): GAIL LAURIE FRIEDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: GAIL LAURIE COLE RN

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 AZAHAR PL
CARLSBAD CA
92009-8302
US

IV. Provider business mailing address

3214 AZAHAR PL
CARLSBAD CA
92009-8302
US

V. Phone/Fax

Practice location:
  • Phone: 760-500-1275
  • Fax:
Mailing address:
  • Phone: 760-500-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN406303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: