Provider Demographics
NPI:1700813698
Name:MARKS, GAIL (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E VANDERBILT WAY
Mailing Address - Street 2:STE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-886-1001
Mailing Address - Fax:909-886-1107
Practice Address - Street 1:350 E VANDERBILT WAY
Practice Address - Street 2:STE B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-886-1001
Practice Address - Fax:909-886-1107
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G456590OtherMEDI CAL
CA00G456590Medicaid
CAP01282954/DU4034OtherRAILROAD MEDICARE
CA00G456590Medicare PIN
CAP01282954/DU4034OtherRAILROAD MEDICARE
CAGB463YMedicare PIN
G22480Medicare UPIN