Provider Demographics
NPI:1093816530
Name:GILL, SUSAN SCOTT (LM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SCOTT
Last Name:GILL
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 E CEDARBROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2494
Mailing Address - Country:US
Mailing Address - Phone:714-222-8759
Mailing Address - Fax:714-923-4485
Practice Address - Street 1:12296 CIRCULA PANORAMA
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1372
Practice Address - Country:US
Practice Address - Phone:714-222-8759
Practice Address - Fax:714-639-7535
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0157176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife