Provider Demographics
NPI:1396949392
Name:GILMAR FATIMA
Entity type:Organization
Organization Name:GILMAR FATIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GILMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FATIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-945-7001
Mailing Address - Street 1:PO BOX 1989
Mailing Address - Street 2:36654 S. LASSEN AVNUE
Mailing Address - City:HURON
Mailing Address - State:CA
Mailing Address - Zip Code:93234-1989
Mailing Address - Country:US
Mailing Address - Phone:559-945-7001
Mailing Address - Fax:
Practice Address - Street 1:36654 S. LASSEN AVENUE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234-1989
Practice Address - Country:US
Practice Address - Phone:559-945-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty