Organization
KAISER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA LYNN GILLILAND NP-C (NURSE PRACTITIONER)
(408) 366-4151
Entity
Organization
Contact information
Practice address
19000 HOMESTEAD, CUPERTINO, CA 95014
(408) 366-4151
Mailing address
PO BOX 458, POLLOCK PINES, CA 95726
(530) 647-1813
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
NPF 11076
CA
Other
Enumeration date
10/03/2006
Last updated
10/22/2008
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