Healthcare Provider Details

I. General information

NPI: 1144728361
Provider Name (Legal Business Name): HARMAN KAUR GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE SUITE 120
SACRAMENTO CA
95825-8343
US

IV. Provider business mailing address

6545 W CELESTE AVE
FRESNO CA
93723-8112
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax:
Mailing address:
  • Phone: 559-367-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: