Provider Demographics
NPI:1053685651
Name:SVETLANA GENTRY, NP
Entity Type:Organization
Organization Name:SVETLANA GENTRY, NP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N.P.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:619-737-7226
Mailing Address - Street 1:719 I AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2017
Mailing Address - Country:US
Mailing Address - Phone:619-737-7226
Mailing Address - Fax:
Practice Address - Street 1:719 I AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2017
Practice Address - Country:US
Practice Address - Phone:619-737-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18073OtherCALIFORNIA STATE BOARD OF NURSING