Healthcare Provider Details

I. General information

NPI: 1790977874
Provider Name (Legal Business Name): GURPREET JOHAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

5620 WILBUR AVE STE 207
TARZANA CA
91356-1309
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5000
  • Fax: 916-851-2884
Mailing address:
  • Phone: 916-966-6544
  • Fax: 916-966-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A9992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: