Healthcare Provider Details

I. General information

NPI: 1528176641
Provider Name (Legal Business Name): GILANTHONY D UNGAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 EUCLID AVE STE 304
NATIONAL CITY CA
91950-8900
US

IV. Provider business mailing address

502 EUCLID AVE STE 304
NATIONAL CITY CA
91950-8900
US

V. Phone/Fax

Practice location:
  • Phone: 619-475-8630
  • Fax: 619-475-8783
Mailing address:
  • Phone: 619-475-8630
  • Fax: 619-475-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA065734
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA065734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: