Healthcare Provider Details

I. General information

NPI: 1770592768
Provider Name (Legal Business Name): GAIL NALLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BEVERLY BLVD STE 218
LOS ANGELES CA
90057-2403
US

IV. Provider business mailing address

6615 S HOLT AVE
LOS ANGELES CA
90056-2211
US

V. Phone/Fax

Practice location:
  • Phone: 213-618-9719
  • Fax: 310-337-1508
Mailing address:
  • Phone: 213-618-9719
  • Fax: 310-337-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberG47276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG47276
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG47276
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG47276
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG47276
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberG47276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: