Provider Demographics
NPI:1851982367
Name:SULE, GARGEE
Entity Type:Individual
Prefix:
First Name:GARGEE
Middle Name:
Last Name:SULE
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 1:3410 GRANDE VISTA PKWY APT NO443
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5294
Mailing Address - Country:US
Mailing Address - Phone:213-245-8785
Mailing Address - Fax:
Practice Address - Street 1:1400 CIRCLE CITY DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1642
Practice Address - Country:US
Practice Address - Phone:951-735-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist