Provider Demographics
NPI:1750628525
Name:MCGILL, MICHAEL I
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MCGILL
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:MCGILL
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1750 S LEWIS RD
Mailing Address - Street 2:A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-765-9050
Mailing Address - Fax:
Practice Address - Street 1:1750 S LEWIS RD
Practice Address - Street 2:A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8520
Practice Address - Country:US
Practice Address - Phone:805-765-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171126164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse