Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G68944 | CA |
NPI | 1003896549 |
---|---|
Provider Name | Dr. Paul Gillbanks |
First Address | Santa Ana, CA 92705-3807 |
Second Address | San Leandro, CA 94578-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 07/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F77420 | (02) | CA |