Healthcare Provider Details

I. General information

NPI: 1700294576
Provider Name (Legal Business Name): MR. GURPREET GREWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TRUXTUN AVE STE 400
BAKERSFIELD CA
93301-5220
US

IV. Provider business mailing address

1430 TRUXTUN AVE STE 400 P.O. BOX 1559
BAKERSFIELD CA
93301-5220
US

V. Phone/Fax

Practice location:
  • Phone: 661-635-3050
  • Fax: 661-869-1503
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-869-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: