Basic Information
| Provider Information | |||||||||
| NPI: | 1265099642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | ANILDEEP | ||||||||
| MiddleName: | SINGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8625 KAUHALE PL | ||||||||
| Address2: | |||||||||
| City: | ORANGEVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956622458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162043003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 S SUNSET AVE | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269624011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.