Healthcare Provider Details

I. General information

NPI: 1285379636
Provider Name (Legal Business Name): PREETPAL SINGH VIRK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 04/30/2022
Certification Date: 04/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

IV. Provider business mailing address

6651 MADISON AVE
CARMICHAEL CA
95608-0602
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-7145
  • Fax:
Mailing address:
  • Phone: 916-903-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: