Provider Demographics
NPI:1417505041
Name:GIL, STEPHANIE (AP, DOM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21750 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1181
Mailing Address - Country:US
Mailing Address - Phone:305-215-6823
Mailing Address - Fax:
Practice Address - Street 1:9225 SW 158TH LN STE D
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1825
Practice Address - Country:US
Practice Address - Phone:305-215-6823
Practice Address - Fax:305-675-7769
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120084100Medicaid