Provider Demographics
NPI:1366467169
Name:GERBER, MICHELE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIA
Last Name:GERBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DRIVE #300
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-901-5200
Mailing Address - Fax:760-637-1887
Practice Address - Street 1:320 SANTA FE DRIVE #300
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-901-5200
Practice Address - Fax:760-637-1887
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17935Medicare UPIN