Healthcare Provider Details

I. General information

NPI: 1548361587
Provider Name (Legal Business Name): GABRIEL GIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 CARDIFF ST
SAN DIEGO CA
92114-5019
US

IV. Provider business mailing address

1924 LAGRANGE RD
CHULA VISTA CA
91913-1690
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-3121
  • Fax: 619-465-6708
Mailing address:
  • Phone: 619-656-8766
  • Fax: 619-656-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: