Gabrielle J Antillon

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

13800 Heacock St Ste C220
Moreno Valley, CA 92553-3363

Phone

(951) 653-1800

Fax

(951) 653-1815

NPI assigned

Feb 23, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Special Service for Groups, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moreno Valley, CA
  • NPI 1093217614
  NPD
• All of God'S Children'S Group Home

  • Case Manager/Care Coordinator
  • Moreno Valley, CA
  • NPI 1477208700
  NPD (past)

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1972259422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST STE C220",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533363",
            "telephone_number": "951-653-1800",
            "fax_number": "951-653-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST STE C220",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533363",
            "telephone_number": "951-653-1800",
            "fax_number": "951-653-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTILLON",
        "first_name": "GABRIELLE",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anim Shoaib M D & Mariah Rubino M D P C
• Tanzila Anis
• Elizabeth Mawuena Ansah
• Shaista Ansari
• Anthony T. Fenison MD Inc
• Antonio a. Tan, MD, Professional Corporation
• Jason Clay Antonio, D.D.S.
• Ap Mobility Inc
• Apindustrie Transportation
• Apple Urgent Care, Inc

• Peer Specialist in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.