Provider Demographics
NPI:1174933428
Name:GILLILAND, LAURA D'AQUILA
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:D'AQUILA
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DEWBERRY
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1235
Mailing Address - Country:US
Mailing Address - Phone:949-874-3812
Mailing Address - Fax:
Practice Address - Street 1:36 DEWBERRY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-1235
Practice Address - Country:US
Practice Address - Phone:949-874-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst