Provider Demographics
NPI:1699706127
Name:GILBERT, SUNAO LYNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:SUNAO
Middle Name:LYNETTE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUNAO
Other - Middle Name:LYNETTE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:638 CAMINO DE LOS MARES # H130-103
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2848
Mailing Address - Country:US
Mailing Address - Phone:310-595-0679
Mailing Address - Fax:
Practice Address - Street 1:2900 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6958
Practice Address - Country:US
Practice Address - Phone:903-773-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32816207P00000X
TXQ2999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A704970Medicaid
CABF469TMedicare PIN
WAG8907191Medicare PIN
AZH81858Medicare UPIN
CA00A704970Medicaid
CAWA70497BMedicare PIN
AZ106551Medicare PIN