Healthcare Provider Details

I. General information

NPI: 1992948855
Provider Name (Legal Business Name): VICTORIA FREESE GILLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE EMERGENCY DEPT
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE EMERGENCY DEPT
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone: 888-750-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA113165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: