Provider Demographics
NPI:1033301874
Name:BAINGO, GAYLE MARIE (RDN)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MARIE
Last Name:BAINGO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W DAVIS WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1201
Mailing Address - Country:US
Mailing Address - Phone:928-380-1610
Mailing Address - Fax:928-774-8606
Practice Address - Street 1:1210 W DAVIS WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1201
Practice Address - Country:US
Practice Address - Phone:928-380-1610
Practice Address - Fax:928-380-1610
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172334OtherAHCCCS