Provider Demographics
NPI:1730259136
Name:BERNTHAL, GAIL (AUD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:BERNTHAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E SHAW AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8105
Mailing Address - Country:US
Mailing Address - Phone:559-448-5640
Mailing Address - Fax:
Practice Address - Street 1:1630 E SHAW AVE # 124
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8105
Practice Address - Country:US
Practice Address - Phone:559-448-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1367174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist