Healthcare Provider Details

I. General information

NPI: 1770408148
Provider Name (Legal Business Name): REGINALLE DANETTE GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA GILL

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST # 5902
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2108 N ST # 5902
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-6828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: