Provider Demographics
NPI:1043876162
Name:GAYLE, KADESH GAMALL (CPO)
Entity type:Individual
Prefix:
First Name:KADESH
Middle Name:GAMALL
Last Name:GAYLE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20595 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0128
Mailing Address - Country:US
Mailing Address - Phone:951-452-3951
Mailing Address - Fax:
Practice Address - Street 1:20595 SPRING ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0128
Practice Address - Country:US
Practice Address - Phone:951-452-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO04275222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist