Provider Demographics
NPI:1710704960
Name:GIL, SERGIO SORIA (AG-ACNP)
Entity type:Individual
Prefix:
First Name:SERGIO SORIA
Middle Name:
Last Name:GIL
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:SORIA-GIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1649
Mailing Address - Country:US
Mailing Address - Phone:707-681-4730
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032221363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty