Healthcare Provider Details

I. General information

NPI: 1922067578
Provider Name (Legal Business Name): CAROL L GILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL GILL DAVIN

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 MURRIETA BLVD
LIVERMORE CA
94550-4190
US

IV. Provider business mailing address

11875 DUBLIN BLVD SUITE C140
DUBLIN CA
94568-2843
US

V. Phone/Fax

Practice location:
  • Phone: 925-449-7795
  • Fax: 925-449-7953
Mailing address:
  • Phone: 925-558-7250
  • Fax: 925-587-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: