Provider Demographics
NPI:1689200321
Name:GIL, TATIANNA KAYLA
Entity Type:Individual
Prefix:MS
First Name:TATIANNA
Middle Name:KAYLA
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 1:51955 ESPERANZA AVE
Mailing Address - Street 2:
Mailing Address - City:CABAZON
Mailing Address - State:CA
Mailing Address - Zip Code:92230-4425
Mailing Address - Country:US
Mailing Address - Phone:951-420-9310
Mailing Address - Fax:
Practice Address - Street 1:6391 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2424
Practice Address - Country:US
Practice Address - Phone:951-440-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst