Brenitta Gilliam-Udo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15518 Issued in CA

Practice address

351 N Mountain View Ave
San Bernardino, CA 92415-1018

Phone

(714) 748-8955

NPI assigned

Aug 20, 2008

Last updated

Aug 20, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: brenitta.gilliamudo.p1@direct.cmcentersinc.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219190400000",
    "number": "1336396548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25064 BARTON RD",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542830",
            "telephone_number": "909-569-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 N MOUNTAIN VIEW AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924151018",
            "telephone_number": "714-748-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM-UDO",
        "first_name": "BRENITTA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "15518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daryl Hilton Gill Jr.
• Jennifer June Gill
• Laney Gill
• Mehar S. Gill, M.D.
• Nicole Gill
• Susan Kimberly Gilliam, LCSW
• Gintien Huang MD Inc (San Bernardino Eye Specialists)
• Daniel Magdy Girgis, M.S.
• Brenda Ruby Giron, M.S.
• Kiarra Gist

• Physician Assistant in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.