Basic Information
| Provider Information | |||||||||
| NPI: | 1811993389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILEWSKI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11406 LOMA LINDA DR RM 105 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095586220 | ||||||||
| FaxNumber: | 9095586278 | ||||||||
| Practice Location | |||||||||
| Address1: | 11406 LOMA LINDA DR RM 105 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095586220 | ||||||||
| FaxNumber: | 9095586278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0700X | PSY 9194 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TR0400X | PSY 9194 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | 103G00000X | PSY 9194 | CA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.