Healthcare Provider Details

I. General information

NPI: 1912636101
Provider Name (Legal Business Name): HARMANDEEP GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC09 5040, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

PO BOX AD
YUBA CITY CA
95992-1396
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6607
  • Fax:
Mailing address:
  • Phone: 866-358-9791
  • Fax: 530-674-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2023-1164
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA202298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: