=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730279548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT ANTHONY GENTILE P.A-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 09/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37553 FREMONT BLVD
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-797-1051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2986 CHEVY WAY
-----------------------------------------------------
City | SAN PABLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94806-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-778-3648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA 12797
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------