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General NPI Number Information
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NPI Number | 1861480998
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Entity Type | Individual
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Provider Name | MARY CECILIA GENTILE DO
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 27699 JEFFERSON AVE # 312
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City | TEMECULA
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State | CA
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Zip | 92590-2661
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Country | US
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Telephone | 951-676-4221
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Fax | 951-676-0032
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Provider Business Mailing Address
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Address Line | 27699 JEFFERSON AVE #312
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City | TEMECULA
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State | CA
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Zip | 92590
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Country | US
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Telephone | 951-676-4221
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Fax | 951-676-0032
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39870
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License Number State | CO
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