Provider Demographics
NPI:1518044809
Name:EDRALIN, GERARD GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:GARY
Last Name:EDRALIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1037 W AVENUE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-2002
Mailing Address - Country:US
Mailing Address - Phone:661-266-8400
Mailing Address - Fax:661-266-8597
Practice Address - Street 1:1037 W AVENUE N
Practice Address - Street 2:SUITE 202
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-2002
Practice Address - Country:US
Practice Address - Phone:661-266-8400
Practice Address - Fax:661-266-8597
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G405450Medicaid
WG40545AMedicare ID - Type Unspecified
CA00G405450Medicaid