Provider Demographics
NPI:1700099249
Name:GENTILE, JASON K (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:GENTILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5929
Mailing Address - Country:US
Mailing Address - Phone:310-376-6262
Mailing Address - Fax:310-376-8228
Practice Address - Street 1:1010 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5929
Practice Address - Country:US
Practice Address - Phone:310-376-6262
Practice Address - Fax:310-376-8228
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95677207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS351VMedicare PIN
CAAS351WMedicare PIN