Healthcare Provider Details

I. General information

NPI: 1689036675
Provider Name (Legal Business Name): JACQUELINE GIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD 2000
LOS ANGELES CA
90010-2501
US

IV. Provider business mailing address

3580 WILSHIRE BLVD 2000
LOS ANGELES CA
90010-2501
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-1250
  • Fax: 213-383-4803
Mailing address:
  • Phone: 213-381-1250
  • Fax: 213-383-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: