Healthcare Provider Details

I. General information

NPI: 1598862815
Provider Name (Legal Business Name): E. ANN GIMPEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 OLD MAMMOTH ROAD 3RD FLOOR
MAMMOTH LAKES CA
93546-2619
US

IV. Provider business mailing address

PO BOX 2675
MAMMOTH LAKES CA
93546-2675
US

V. Phone/Fax

Practice location:
  • Phone: 760-924-1740
  • Fax: 760-924-1741
Mailing address:
  • Phone: 760-934-2051
  • Fax: 760-934-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 15153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: