Provider Demographics
NPI:1952441370
Name:LINDBLOM, GAIL TERESA
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:TERESA
Last Name:LINDBLOM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:TERESA
Other - Last Name:BUMGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-2632
Mailing Address - Country:US
Mailing Address - Phone:760-379-3412
Mailing Address - Fax:760-379-5332
Practice Address - Street 1:2731 NUGGET AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-3412
Practice Address - Fax:760-379-5332
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator