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General NPI Number Information
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NPI Number | 1619525037
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Entity Type | Individual
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Provider Name | KAYLEEN GILLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 333 SE 7TH AVE STE 2500
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City | HILLSBORO
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State | OR
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Zip | 97123-4157
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Country | US
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Telephone | 503-844-8280
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Fax | 503-346-8449
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Provider Business Mailing Address
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Address Line | 1400 SW 5TH AVE STE 500
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City | PORTLAND
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State | OR
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Zip | 97201-5537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 10940
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA218628
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License Number State | OR
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