Provider Demographics
NPI:1548217292
Name:GILBERT, JEANNE (PA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:138 W MAIN ST
Practice Address - Street 2:UNIT E
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2584
Practice Address - Country:US
Practice Address - Phone:805-667-2851
Practice Address - Fax:805-652-0708
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12820363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40394FMedicaid
CARHM08608FMedicaid
CA95-1683892OtherOTHER INSURANCE
CARHM08609FMedicaid
CARHM18553HMedicaid
CAWPA12820FMedicare ID - Type UnspecifiedPPIN
CAZZT40394FMedicaid
CAWPA12820BMedicare ID - Type UnspecifiedPPIN
CAWPA12820CMedicare ID - Type UnspecifiedPPIN
CAWPA12820EMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CARHM08608FMedicaid