Healthcare Provider Details

I. General information

NPI: 1962365668
Provider Name (Legal Business Name): GENTEELE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 MOUNT OLIVE DR APT 1
DUARTE CA
91010-2173
US

IV. Provider business mailing address

921 MOUNT OLIVE DR APT 1
DUARTE CA
91010-2173
US

V. Phone/Fax

Practice location:
  • Phone: 310-692-3475
  • Fax:
Mailing address:
  • Phone: 310-692-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID LEONARD PERRY JR.
Title or Position: OWNER
Credential:
Phone: 310-692-3475