Healthcare Provider Details

I. General information

NPI: 1033854674
Provider Name (Legal Business Name): AMANPREET MANGAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

1375 E GRANDE AVE SUITE 103 PMB#604
ARROYO GRANDE CA
93420
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123297
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: