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General NPI Number Information
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NPI Number | 1609320746
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Entity Type | Individual
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Provider Name | CAREY W. GENTRY CRT
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Gender | Male
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 333 E RAINBOW DR
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City | AZUSA
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State | CA
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Zip | 91702-2134
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Country | US
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Telephone | 626-487-9992
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1537
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City | MONROVIA
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State | CA
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Zip | 91017
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Country | US
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Telephone | 626-595-0657
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Fax | 626-628-1791
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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 | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | RHT00063982
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License Number State | CA
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