Provider Demographics
NPI:1588728786
Name:GILMARTIN, CHARLES KIM (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KIM
Last Name:GILMARTIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:415-642-0707
Practice Address - Fax:650-755-8638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2838367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ15131Medicare UPIN
CAP01416329Medicare PIN
CACA121008Medicare PIN