Healthcare Provider Details

I. General information

NPI: 1265722870
Provider Name (Legal Business Name): TEJINDER KHERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 GREEN VALLEY RD
CAMERON PARK CA
95682-7647
US

IV. Provider business mailing address

508 SAN MARCO PL
EL DORADO HILLS CA
95762-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-672-8908
  • Fax:
Mailing address:
  • Phone: 530-933-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: