Provider Demographics
NPI:1427429612
Name:GILL, GURPAL (RADT)
Entity type:Individual
Prefix:
First Name:GURPAL
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SPAANS DR STE CDF
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8609
Mailing Address - Country:US
Mailing Address - Phone:209-744-9909
Mailing Address - Fax:
Practice Address - Street 1:101 PARKSHORE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:650-564-4317
Practice Address - Fax:916-932-2001
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAR1433940621101YA0400X
CA86303106H00000X
CA129935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)