Provider Demographics
NPI:1891851861
Name:GILL, CADRIN EMMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CADRIN
Middle Name:EMMANUEL
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W VERNON AVE
Mailing Address - Street 2:101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2700
Mailing Address - Country:US
Mailing Address - Phone:323-231-5181
Mailing Address - Fax:323-231-9909
Practice Address - Street 1:231 W VERNON AVE
Practice Address - Street 2:101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2700
Practice Address - Country:US
Practice Address - Phone:323-231-5181
Practice Address - Fax:323-231-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG34954Medicaid
CAG34954Medicaid
CAA91644Medicare PIN