Provider Demographics
NPI:1275666059
Name:GILDEN, LIZA ANNMARIE
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:ANNMARIE
Last Name:GILDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ANNEMARIE
Other - Last Name:GILDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3930 BRIDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219
Mailing Address - Country:US
Mailing Address - Phone:209-603-4739
Mailing Address - Fax:
Practice Address - Street 1:7300 LINCOLNSHIRE DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2099
Practice Address - Country:US
Practice Address - Phone:916-282-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator