Provider Demographics
NPI:1699333633
Name:GILLOTT HEALD, DEBRA JEAN (ND)
Entity type:Individual
Prefix:DR
First Name:DEBRA JEAN
Middle Name:
Last Name:GILLOTT HEALD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:HEALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:373 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5103
Mailing Address - Country:US
Mailing Address - Phone:650-448-5078
Mailing Address - Fax:
Practice Address - Street 1:373 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5103
Practice Address - Country:US
Practice Address - Phone:650-448-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND875175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAND875OtherDCA LICENCE