Provider Demographics
NPI:1518218320
Name:DR. GAYLE DEUTSCH
Entity Type:Organization
Organization Name:DR. GAYLE DEUTSCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-224-0485
Mailing Address - Street 1:1089 TANLAND DR
Mailing Address - Street 2:APT 113
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5698
Practice Address - Country:US
Practice Address - Phone:650-224-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR514ZMedicare UPIN