Provider Demographics
NPI:1033286638
Name:GILLO, ARLENE TUBIERA (LAC)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:TUBIERA
Last Name:GILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6711 FOREST LAWN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1046
Mailing Address - Country:US
Mailing Address - Phone:323-851-7876
Mailing Address - Fax:323-851-7870
Practice Address - Street 1:6711 FOREST LAWN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1046
Practice Address - Country:US
Practice Address - Phone:323-851-7876
Practice Address - Fax:323-851-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist