Provider Demographics
NPI:1881057560
Name:GILL, KANVAL S
Entity type:Individual
Prefix:
First Name:KANVAL
Middle Name:S
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-7791
Mailing Address - Country:US
Mailing Address - Phone:805-382-6296
Mailing Address - Fax:
Practice Address - Street 1:2150 N VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-7791
Practice Address - Country:US
Practice Address - Phone:805-382-6296
Practice Address - Fax:805-382-9487
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical