Individual
MR. ETHAN GENTILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6621 E PACIFIC COAST HWY, LONG BEACH, CA 90803-4200
(562) 270-6344
Mailing address
2255 W BROADWAY APT G102, ANAHEIM, CA 92804-1369
(714) 929-6524
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
CA
Other
Enumeration date
05/30/2017
Last updated
05/30/2017
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