Provider Demographics
NPI:1174136097
Name:GB MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:GB MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:909-438-8668
Mailing Address - Street 1:9670 CENTRAL AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2425
Mailing Address - Country:US
Mailing Address - Phone:909-438-8668
Mailing Address - Fax:
Practice Address - Street 1:9670 CENTRAL AVE STE 111
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2425
Practice Address - Country:US
Practice Address - Phone:909-438-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty