Healthcare Provider Details

I. General information

NPI: 1588726764
Provider Name (Legal Business Name): RACHEL ANN GILLAM BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL ANN GILLAM BS

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 HOWARD RD STE 125
MADERA CA
93637-5155
US

IV. Provider business mailing address

1131 S ILA AVE
FRESNO CA
93706-2411
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-0105
  • Fax:
Mailing address:
  • Phone: 713-775-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: