Provider Demographics
NPI:1093913899
Name:GENTILI, JULIAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
Last Name:GENTILI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 BALBOA AVE
Mailing Address - Street 2:1058
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:858-863-7577
Mailing Address - Fax:
Practice Address - Street 1:4231 BALBOA AVE
Practice Address - Street 2:1058
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5504
Practice Address - Country:US
Practice Address - Phone:858-863-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36745225100000X
AZ7687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.010713OtherPHYSICAL THERAPIST LICENS
AZ7687OtherPHYSICAL THERAPIST LICENS