Healthcare Provider Details

I. General information

NPI: 1174654818
Provider Name (Legal Business Name): INDRANI GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 14TH ST STE 409
RIVERSIDE CA
92501-4010
US

IV. Provider business mailing address

4000 14TH ST STE 409
RIVERSIDE CA
92501-4010
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-2770
  • Fax: 951-788-2848
Mailing address:
  • Phone: 951-788-2770
  • Fax: 951-788-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA41654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: