Healthcare Provider Details

I. General information

NPI: 1689658064
Provider Name (Legal Business Name): ANNE IRELAND-GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HOLSER WALK SUITE #305
OXNARD CA
93036-2633
US

IV. Provider business mailing address

29420 CRESTHAVEN CT
AGOURA HILLS CA
91301-4129
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-2824
  • Fax: 805-485-2774
Mailing address:
  • Phone: 818-889-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG69734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: