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NPI Code Detail

MEDICARE: MR. ANDREW GRANT GILL ATC

MEDICARE:  MR. ANDREW GRANT GILL  ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1558350983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW GRANT GILL ATC
Provider Business Mailing Address
First Line : 18229 REGINA AVE
Second Line :
City : TORRANCE
State : CA
Zip : 90504-4609
Country : US
Telephone Number : 310-703-4549
Fax Number :
Provider Business Practice Location Address
First Line : 5772 BOLSA AVE
Second Line : SUITE 101
City : HUNTINGTON BEACH
State : CA
Zip : 92649-1134
Country : US
Telephone Number : 714-897-3589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 07/08/2007

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Directions to “ MR. ANDREW GRANT GILL ATC” Practice Location

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