MEDICARE: JEAN WARREN GILLON MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	G56808	CA

General Provider Information

NPI Number	:	1417391541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEAN WARREN GILLON MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2900 WHIPPLE AVE STE 200
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2864
Country	:	US
Telephone Number	:	650-364-3828
Fax Number	:	650-361-1727

Provider Business Practice Location Address
First Line	:	2900 WHIPPLE AVE STE 200
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2864
Country	:	US
Telephone Number	:	650-364-3828
Fax Number	:	650-361-1727

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEAN WARREN GILLON
Credential	:	M.D.
Telephone Number	:	650-364-3828

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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