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General NPI Number Information
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NPI Number | 1881197200
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Entity Type | Individual
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Provider Name | TANYA N GENTRY
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Gender | Female
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 25845 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3899
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Country | US
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Telephone | 909-558-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 CAMPUS ST STE A1121B
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City | LOMA LINDA
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State | CA
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Zip | 92350-1700
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A20574
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License Number State | CA
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