Healthcare Provider Details

I. General information

NPI: 1649974155
Provider Name (Legal Business Name): NICHOLAS GILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 N MILBURN AVE STE 101
FRESNO CA
93722-2161
US

IV. Provider business mailing address

7005 N MILBURN AVE STE 101
FRESNO CA
93722-2161
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7400
  • Fax: 559-603-7649
Mailing address:
  • Phone: 559-603-7400
  • Fax: 559-603-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: