Provider Demographics
NPI:1609320746
Name:GENTRY, CAREY W (CRT)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:W
Last Name:GENTRY
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1537
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017
Mailing Address - Country:US
Mailing Address - Phone:626-595-0657
Mailing Address - Fax:626-628-1791
Practice Address - Street 1:333 E RAINBOW DR
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2134
Practice Address - Country:US
Practice Address - Phone:626-487-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT00063982335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA813805691OtherPORTABLE X-RAY