Individual
PRABHJOT GILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 576-8181
Mailing address
2800 SAINT PAUL DR APT 245, SANTA ROSA, CA 95405-8505
(352) 362-1499
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95237192
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95237192
—
CA
Enumeration date
03/22/2021
Last updated
03/22/2021
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