Provider Demographics
NPI:1407389489
Name:GILLILAND, SARAH DAWN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DAWN
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 MISSION GORGE RD STE N
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3026
Mailing Address - Country:US
Mailing Address - Phone:619-383-6868
Mailing Address - Fax:
Practice Address - Street 1:10201 MISSION GORGE RD STE N
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3026
Practice Address - Country:US
Practice Address - Phone:619-383-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373781Medicaid