Provider Demographics
NPI:1285902080
Name:HUMBLE, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 N PCH HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3149
Mailing Address - Country:US
Mailing Address - Phone:310-379-4838
Mailing Address - Fax:310-379-1121
Practice Address - Street 1:101 N PCH HWY STE 102
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3149
Practice Address - Country:US
Practice Address - Phone:310-379-4838
Practice Address - Fax:310-379-1121
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40624170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics