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General NPI Number Information
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NPI Number | 1184639031
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Entity Type | Individual
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Provider Name | GERARD IRVELT BAZILE MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 8525 GIBBS DR SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92123-1755
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Country | US
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Telephone | 858-505-9436
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Fax | 858-505-9568
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Provider Business Mailing Address
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Address Line | 1750 KETTNER BLVD UNIT 106
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City | SAN DIEGO
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State | CA
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Zip | 92101-2531
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Country | US
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Telephone | 858-505-9436
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Fax | 858-505-9568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G87229
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License Number State | CA
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