Provider Demographics
NPI:1093340085
Name:GILBERT, VIRGINIA CORETTA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CORETTA
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:CORETTA
Other - Last Name:GILBERT-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3118 CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2726
Mailing Address - Country:US
Mailing Address - Phone:510-992-9320
Mailing Address - Fax:
Practice Address - Street 1:3118 CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2726
Practice Address - Country:US
Practice Address - Phone:510-992-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider