Healthcare Provider Details

I. General information

NPI: 1790700458
Provider Name (Legal Business Name): HARMANDEEP K GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43830 10TH ST W
LANCASTER CA
93534-4826
US

IV. Provider business mailing address

PO BOX 26750
FRESNO CA
93729-6750
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-4781
  • Fax:
Mailing address:
  • Phone: 661-948-4781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA51452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: