Provider Demographics
NPI:1770592768
Name:NALLS, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:NALLS
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 1:6615 S HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-2211
Mailing Address - Country:US
Mailing Address - Phone:213-618-9719
Mailing Address - Fax:310-337-1508
Practice Address - Street 1:2001 BEVERLY BLVD STE 218
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2403
Practice Address - Country:US
Practice Address - Phone:213-618-9719
Practice Address - Fax:310-337-1508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG472762085U0001X, 2085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47276COtherMEDICARE
CA00G472760Medicaid
CAG47276AOtherMEDICARE
CAG47276BOtherMEDICARE
CAG47276BOtherMEDICARE