MEDICARE: JOHN R. GILLETTE M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C29328	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ91891Z	OTHER	CA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
3	ZZZ91892Z	OTHER	CA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
5	ZZZ92069Z	OTHER	CA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C29328	OTHER	CA	PROFESSIONAL LICENSE #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1598756579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R. GILLETTE M.D.

Provider Business Mailing Address
First Line	:	1400 EMELINE AVE
Second Line	:	2ND FLOOR
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

Provider Business Practice Location Address
First Line	:	1400 EMELINE AVE
Second Line	:	2ND FLOOR
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/07/2023

1400 EMELINE AVE BLDG K
SANTA CRUZ, CA
95060-1976

Practice Phone: 831-454-4170
Practice Fax: