Healthcare Provider Details

I. General information

NPI: 1164555876
Provider Name (Legal Business Name): ANGELA GILMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 AMARGOSA RD STE 1
VICTORVILLE CA
92392-8102
US

IV. Provider business mailing address

16808 MAIN ST STE D-146
HESPERIA CA
92345-7922
US

V. Phone/Fax

Practice location:
  • Phone: 442-414-3090
  • Fax:
Mailing address:
  • Phone: 442-414-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW83194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: