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NPI Code Detail

MEDICARE: MS. RUTH ANNE GILLIS MC MFT

MEDICARE: MS. RUTH ANNE GILLIS MC MFT
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
1106H00000XMarriage & Family Therapist50313CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15979OTHERCASAN DIEGO COUNTY #

General Provider Information

NPI Number : 1568588325
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUTH ANNE GILLIS MC MFT
Provider Business Mailing Address
First Line : 9338 KENWOOD DR
Second Line :
City : SPRING VALLEY
State : CA
Zip : 91977-2424
Country : US
Telephone Number : 619-341-3747
Fax Number : 619-341-4737
Provider Business Practice Location Address
First Line : 1250 6TH AVE STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-4368
Country : US
Telephone Number : 619-515-2430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 03/17/2018

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