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General NPI Number Information
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NPI Number | 1861839565
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Entity Type | Organization
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Legal Business Name | EVANGELINE A. GIMBEL, MD INC.
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 7950 CHERRY AVE SUITE 105
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City | FONTANA
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State | CA
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Zip | 92336-4022
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Country | US
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Telephone | 909-434-1657
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Fax | 909-231-6231
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Provider Business Mailing Address
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Address Line | 7950 CHERRY AVE SUITE 105
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City | FONTANA
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State | CA
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Zip | 92336-4022
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Country | US
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Telephone | 909-434-1657
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Fax | 909-231-6231
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Authorized Official
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Title or Position | OWNER
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Name | EVANGELINE A GIMBEL
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Credential | M.D.
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Telephone | 909-434-1657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A50667
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License Number State | CA
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