Healthcare Provider Details

I. General information

NPI: 1316147937
Provider Name (Legal Business Name): HARMANDEEP K. GILL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHICAGO AVE #C-3
RIVERSIDE CA
92507-2206
US

IV. Provider business mailing address

PO BOX 26750
FRESNO CA
93729-6750
US

V. Phone/Fax

Practice location:
  • Phone: 951-786-0801
  • Fax: 951-786-0460
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HARMANDEEP K. GILL
Title or Position: OWNER
Credential: M.D.
Phone: 661-948-4781