Provider Demographics
NPI:1467498634
Name:GENTRY, YVETTE MARCELLA (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARCELLA
Last Name:GENTRY
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 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3126
Mailing Address - Country:US
Mailing Address - Phone:510-653-0846
Mailing Address - Fax:
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3126
Practice Address - Country:US
Practice Address - Phone:510-653-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76174207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76174OtherSTATE LICENSE
CAGR0089640OtherMEDICAL
CAGR0089640OtherMEDICAL
CA00G761740Medicare ID - Type Unspecified
CAGR0089640OtherMEDICAL