Individual
MISS JENNIFER DANIELLE GAITLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1919 E THOMAS RD FL 2, PHOENIX, AZ 85016-7710
(602) 933-3033
(602) 933-4311
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
(602) 933-8972
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2017-02087
NC
2080S0010X
Pediatric Sports Medicine Physician
2017-02087
NC
2080S0010X
Pediatric Sports Medicine Physician
Primary
60285
AZ
Other
Enumeration date
06/22/2012
Last updated
12/10/2020
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