Provider Demographics
NPI:1730864406
Name:GENTRY, ASHLEY CLARA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CLARA
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E WASHINGTON AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2189
Mailing Address - Country:US
Mailing Address - Phone:442-317-9969
Mailing Address - Fax:
Practice Address - Street 1:1021 MEMORY LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1722
Practice Address - Country:US
Practice Address - Phone:480-739-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF5150114OtherDRIVER LICENSE