Provider Demographics
NPI:1760216600
Name:GIL RONDON, MIRTHA I
Entity type:Individual
Prefix:
First Name:MIRTHA
Middle Name:I
Last Name:GIL RONDON
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 1:5034 HOLT BLVD TRLR A10
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4818
Mailing Address - Country:US
Mailing Address - Phone:747-313-1793
Mailing Address - Fax:
Practice Address - Street 1:77711 FLORA RD STE 327
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4103
Practice Address - Country:US
Practice Address - Phone:909-726-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician