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General NPI Number Information
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NPI Number | 1457119984
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Entity Type | Individual
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Provider Name | PHILIP GERNERT
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Gender | Male
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | SR 108, BLDG. 3005
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City | BRIDGEPORT
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State | CA
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Zip | 93517-9802
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Country | US
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Telephone | 760-932-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 SIERRA ST. BUILDING 3005
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City | FPO
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State | AA
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Zip | 93517
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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