Provider Demographics
NPI:1821618893
Name:JOHNSON-MCINTYRE, GAIL EVONNE
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:EVONNE
Last Name:JOHNSON-MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14344 CAJON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4301
Mailing Address - Country:US
Mailing Address - Phone:760-243-3999
Mailing Address - Fax:760-243-9449
Practice Address - Street 1:14344 CAJON AVE STE 102
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4301
Practice Address - Country:US
Practice Address - Phone:760-243-3999
Practice Address - Fax:760-243-9449
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health