Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO04275 | CA |
Y | 222Z00000X | Podiatrist | CPO04275 | CA |
NPI | 1043876162 |
---|---|
Provider Name | Kadesh Gamall Gayle |
First Address | Riverside, CA 92507-0128 |
Second Address | Riverside, CA 92507-0128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2019 |
Last Update Date | 14/05/2019 |