Healthcare Provider Details

I. General information

NPI: 1033901020
Provider Name (Legal Business Name): BHAGWANTPAL KAUR DAODA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 BLOSSOM WAY
CHERRYLAND CA
94541-1948
US

IV. Provider business mailing address

20649 AGNES LN
CHERRYLAND CA
94541-1801
US

V. Phone/Fax

Practice location:
  • Phone: 510-582-7676
  • Fax:
Mailing address:
  • Phone: 510-213-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95404559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: