Provider Demographics
NPI:1912254798
Name:GILKER, DIANA JEAN (NP)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:JEAN
Last Name:GILKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 FALMOUTH AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8228
Mailing Address - Country:US
Mailing Address - Phone:310-972-1525
Mailing Address - Fax:
Practice Address - Street 1:2573 PACIFIC COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7950
Practice Address - Country:US
Practice Address - Phone:310-953-3269
Practice Address - Fax:310-933-0258
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22231363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care