Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A98725 | CA |
Y | 207VG0400X | Gynecologist | 48658 | AZ |
NPI | 1063745941 |
---|---|
Provider Name | Denise Gentles |
First Address | Phoenix, AZ 85004-4608 |
Second Address | Phoenix, AZ 85033-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 02/04/2015 |