Provider Demographics
NPI:1902543069
Name:DE JUAN SILAB, GESILLE
Entity Type:Individual
Prefix:
First Name:GESILLE
Middle Name:
Last Name:DE JUAN SILAB
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 1:1628 S MONTE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8588
Mailing Address - Country:US
Mailing Address - Phone:951-567-0558
Mailing Address - Fax:
Practice Address - Street 1:1628 S MONTE VERDE DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8588
Practice Address - Country:US
Practice Address - Phone:951-567-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612354163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse