Provider Demographics
NPI:1700250206
Name:GILL, SYMONE (LVN)
Entity Type:Individual
Prefix:
First Name:SYMONE
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 APPLE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4492
Mailing Address - Country:US
Mailing Address - Phone:760-547-1280
Mailing Address - Fax:760-547-1268
Practice Address - Street 1:1919 APPLE ST
Practice Address - Street 2:SUITE G
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4492
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:760-547-1268
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN270397164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse