Provider Demographics
NPI:1598207110
Name:GILLAMAC, MARIA ABENA (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ABENA
Last Name:GILLAMAC
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15464 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6149
Mailing Address - Country:US
Mailing Address - Phone:714-891-9008
Mailing Address - Fax:
Practice Address - Street 1:15464 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6149
Practice Address - Country:US
Practice Address - Phone:714-891-9008
Practice Address - Fax:714-897-7949
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily