Healthcare Provider Details

I. General information

NPI: 1285361014
Provider Name (Legal Business Name): RAJDEEP KAUR BASRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE 101
CLOVIS CA
93611-6316
US

IV. Provider business mailing address

5467 E EUGENIA AVE
FRESNO CA
93727-6382
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-4315
  • Fax:
Mailing address:
  • Phone: 503-470-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: