MEDICARE: JOSEPH MARK GENTILE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	G1110092043	CA

General Provider Information

NPI Number	:	1669718136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MARK GENTILE

Provider Business Mailing Address
First Line	:	271 WATER ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4009
Country	:	US
Telephone Number	:	831-427-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 WATER ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4009
Country	:	US
Telephone Number	:	831-427-5290
Fax Number	:

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

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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Directions to “ JOSEPH MARK GENTILE ” Practice Location

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