Provider Demographics
NPI:1912363243
Name:BRUCE S. GILLIS, M.D., M.P.H., INC.
Entity Type:Organization
Organization Name:BRUCE S. GILLIS, M.D., M.P.H., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:319-551-1940
Mailing Address - Street 1:1940 CENTURY PARK E
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1700
Mailing Address - Country:US
Mailing Address - Phone:310-551-1940
Mailing Address - Fax:
Practice Address - Street 1:1940 CENTURY PARK E
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-1700
Practice Address - Country:US
Practice Address - Phone:310-551-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30367261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service