Healthcare Provider Details

I. General information

NPI: 1760680532
Provider Name (Legal Business Name): GIL RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23615 EL TORO RD SUITE 350
LAKE FOREST CA
92630-4707
US

IV. Provider business mailing address

23615 EL TORO RD SUITE 350
LAKE FOREST CA
92630-4707
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-3400
  • Fax: 949-264-1681
Mailing address:
  • Phone: 949-305-3400
  • Fax: 949-264-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO MARCIANO
Title or Position: OWNER
Credential:
Phone: 949-770-6022