MEDICARE: MR. JULIAN GENTILI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	36745	CA

General Provider Information

NPI Number	:	1093913899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULIAN GENTILI PT

Provider Business Mailing Address
First Line	:	4231 BALBOA AVE
Second Line	:	1058
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	858-863-7577
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 BALBOA AVE
Second Line	:	1058
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	858-863-7577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	04/05/2017

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