Provider Demographics
NPI:1508240458
Name:GILL, LIZA (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12565 HESPERIA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8318
Mailing Address - Country:US
Mailing Address - Phone:760-780-0003
Mailing Address - Fax:760-766-1908
Practice Address - Street 1:12565 HESPERIA RD STE 3
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8318
Practice Address - Country:US
Practice Address - Phone:760-780-0003
Practice Address - Fax:760-766-1908
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2024-02-04
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Provider Licenses
StateLicense IDTaxonomies
CAA159076207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology