Provider Demographics
NPI:1265574867
Name:TOMINAGA, GAIL T (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:T
Last Name:TOMINAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 85466
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92186-5466
Mailing Address - Country:US
Mailing Address - Phone:858-626-6362
Mailing Address - Fax:858-626-6354
Practice Address - Street 1:9888 GENESEE AVE
Practice Address - Street 2:LJ-601
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1205
Practice Address - Country:US
Practice Address - Phone:858-626-6362
Practice Address - Fax:858-626-6354
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57834208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G578340Medicaid
E72640Medicare UPIN
CA00G578340Medicaid