Healthcare Provider Details

I. General information

NPI: 1629704317
Provider Name (Legal Business Name): RATINDERJEET KAUR GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 E HERNDON AVE
FRESNO CA
93720-0300
US

IV. Provider business mailing address

2902 N BRIX AVE
FRESNO CA
93722-0400
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-0883
  • Fax:
Mailing address:
  • Phone: 559-835-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number726104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: