Provider Demographics
NPI:1942098538
Name:GILLES, GEORGE KENZO
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:KENZO
Last Name:GILLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DRIVE
Mailing Address - Street 2:ACHS-GME OFFICE STE 201
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-773-4504
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DRIVE
Practice Address - Street 2:ACHS-GME OFFICE STE 201
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-773-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program