Provider Demographics
NPI:1790253672
Name:GILL, NAVDEEP KAUR (PA-C)
Entity Type:Individual
Prefix:
First Name:NAVDEEP
Middle Name:KAUR
Last Name:GILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NAVDEEP
Other - Middle Name:KAUR
Other - Last Name:ATWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31581 CANYON ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0424
Mailing Address - Country:US
Mailing Address - Phone:951-244-3500
Mailing Address - Fax:951-244-3535
Practice Address - Street 1:31581 CANYON ESTATES DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0424
Practice Address - Country:US
Practice Address - Phone:951-244-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56086363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical