Basic Information
Provider Information
NPI: 1003015132
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILL
FirstName: RETHEL
MiddleName: E.
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2647 21ST ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941102829
CountryCode: US
TelephoneNumber: 4159026533
FaxNumber:  
Practice Location
Address1: 1927 OTOOLE WAY
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951312238
CountryCode: US
TelephoneNumber: 7078618276
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/18/2007
LastUpdateDate: 04/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPSY27098CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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