Provider Demographics
NPI:1548632649
Name:GILILA, CLARISSA
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:GILILA
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:PO BOX 8107
Mailing Address - Street 2:101 ARMY WAY
Mailing Address - City:TUNTUTULIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 ARMY WAY
Practice Address - Street 2:
Practice Address - City:TUNTUTULIAK
Practice Address - State:AK
Practice Address - Zip Code:99680
Practice Address - Country:US
Practice Address - Phone:907-256-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker