MEDICARE: EVANGELINE AUSTRIA GIMBEL MD

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	208000000X	Pediatrics Physician	A050667	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164493888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINE AUSTRIA GIMBEL MD

Provider Business Mailing Address
First Line	:	7950 CHERRY AVE
Second Line	:	SUITE 105
City	:	FONTANA
State	:	CA
Zip	:	92336-4022
Country	:	US
Telephone Number	:	909-434-1657
Fax Number	:	909-231-6231

Provider Business Practice Location Address
First Line	:	7950 CHERRY AVE
Second Line	:	SUITE 105
City	:	FONTANA
State	:	CA
Zip	:	92336-4022
Country	:	US
Telephone Number	:	909-434-1657
Fax Number	:	909-231-6231

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	06/04/2013

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