Healthcare Provider Details

I. General information

NPI: 1861336398
Provider Name (Legal Business Name): RAVNEET KAUR JOHAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

27101 N 23RD DR
PHOENIX AZ
85085-8715
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8798
  • Fax:
Mailing address:
  • Phone: 559-367-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: