Provider Demographics
NPI:1063260529
Name:GILPIN, ALECIA DANIELLE
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:DANIELLE
Last Name:GILPIN
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 1:845 S VINEYARD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3535
Mailing Address - Country:US
Mailing Address - Phone:480-514-7876
Mailing Address - Fax:
Practice Address - Street 1:845 S VINEYARD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3535
Practice Address - Country:US
Practice Address - Phone:480-514-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ123456202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology