Healthcare Provider Details

I. General information

NPI: 1104634294
Provider Name (Legal Business Name): HARINDER SINGH DHILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4113
US

IV. Provider business mailing address

3801 SHELLEY ANNE WAY
BAKERSFIELD CA
93311-8418
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8080
  • Fax:
Mailing address:
  • Phone: 661-421-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95372096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: