Provider Demographics
NPI:1841451408
Name:JONATHAN P. GALE D.O. INC.
Entity type:Organization
Organization Name:JONATHAN P. GALE D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-677-5200
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-677-5200
Mailing Address - Fax:951-677-5323
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-677-5200
Practice Address - Fax:951-677-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN606AMedicare PIN