Healthcare Provider Details

I. General information

NPI: 1588506208
Provider Name (Legal Business Name): KIRANJOT DHALIWAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N MEDICAL CENTER DR E STE 209
CLOVIS CA
93611-6886
US

IV. Provider business mailing address

1603 E CLUBHOUSE DR
FRESNO CA
93730-7016
US

V. Phone/Fax

Practice location:
  • Phone: 559-349-7888
  • Fax:
Mailing address:
  • Phone: 559-349-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF06262065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: