Provider Demographics
NPI:1689036675
Name:GIL, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GIL
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 1:3580 WILSHIRE BLVD
Mailing Address - Street 2:2000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2501
Mailing Address - Country:US
Mailing Address - Phone:213-381-1250
Mailing Address - Fax:213-383-4803
Practice Address - Street 1:3580 WILSHIRE BLVD
Practice Address - Street 2:2000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2501
Practice Address - Country:US
Practice Address - Phone:213-381-1250
Practice Address - Fax:213-383-4803
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker