Healthcare Provider Details

I. General information

NPI: 1639260292
Provider Name (Legal Business Name): TIRATH SINGH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 W HERNDON AVE STE 300
FRESNO CA
93711-0552
US

IV. Provider business mailing address

1470 W HERNDON AVE STE 300
FRESNO CA
93711-0552
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-2000
  • Fax: 559-256-3000
Mailing address:
  • Phone: 559-256-2000
  • Fax: 559-256-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC51319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC51319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: