Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | C40624 | CA |
NPI | 1285902080 |
---|---|
Provider Name | Gail Humble |
First Address | Redondo Beach, CA 90277-3149 |
Second Address | Redondo Beach, CA 90277-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2011 |
Last Update Date | 07/12/2011 |