MEDICARE: RAVIJOT GILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A10555	CA

General Provider Information

NPI Number	:	1104070085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVIJOT GILL

Provider Business Mailing Address
First Line	:	2776 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2683 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2610
Country	:	US
Telephone Number	:	562-230-6424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	12/21/2009

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