Provider Demographics
NPI:1023291754
Name:GILLILAN, REBECCA (CNIM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GILLILAN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SONTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4080 N JULIANO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-0401
Mailing Address - Country:US
Mailing Address - Phone:702-883-9401
Mailing Address - Fax:
Practice Address - Street 1:4080 N JULIANO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-0401
Practice Address - Country:US
Practice Address - Phone:702-883-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1640246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1640OtherCNIM