Provider Demographics
NPI:1770366841
Name:FITZPATRICK, GILLIAN GRACE
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:GRACE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:GRACE
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22968 VIA NUEZ
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2580
Mailing Address - Country:US
Mailing Address - Phone:661-300-1272
Mailing Address - Fax:661-300-1272
Practice Address - Street 1:22968 VIA NUEZ
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2580
Practice Address - Country:US
Practice Address - Phone:661-300-1272
Practice Address - Fax:661-300-1272
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician