Healthcare Provider Details

I. General information

NPI: 1205765658
Provider Name (Legal Business Name): SUMEET JOHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WESTWIND DR STE 227
BAKERSFIELD CA
93301-3047
US

IV. Provider business mailing address

2602 GANTRY DR
MANTECA CA
95337-2097
US

V. Phone/Fax

Practice location:
  • Phone: 209-841-9001
  • Fax: 661-404-4925
Mailing address:
  • Phone: 209-841-9001
  • Fax: 661-404-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: