Healthcare Provider Details

I. General information

NPI: 1700041506
Provider Name (Legal Business Name): ANUREET KAUR GILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 W MARCH LN STE 5
STOCKTON CA
95219-2354
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-475-5500
  • Fax: 209-475-5535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1.053789
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number262234
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number259023
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC153088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: