Provider Demographics
NPI:1114158458
Name:GILMORE, JOY MONDRAGON (MS)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:MONDRAGON
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 LAFITTE DR
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4720
Mailing Address - Country:US
Mailing Address - Phone:818-292-2761
Mailing Address - Fax:818-225-8987
Practice Address - Street 1:1911 WILLIAMS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:805-981-4221
Practice Address - Fax:805-981-6838
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health