Healthcare Provider Details

I. General information

NPI: 1831499607
Provider Name (Legal Business Name): GAYLE R MISLE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15035 E 14TH ST
SAN LEANDRO CA
94578-1901
US

IV. Provider business mailing address

PO BOX 2186
CASTRO VALLEY CA
94546-0186
US

V. Phone/Fax

Practice location:
  • Phone: 510-885-0225
  • Fax:
Mailing address:
  • Phone: 510-885-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG38840
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG38840
License Number StateCA

VIII. Authorized Official

Name: DR. GAYLE R MISLE MD PC
Title or Position: OWNER
Credential: MD
Phone: 510-885-0225