Healthcare Provider Details

I. General information

NPI: 1396372629
Provider Name (Legal Business Name): JABERPREET SINGH DHALIWAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 FALLON RD STE 431
DUBLIN CA
94568-7400
US

IV. Provider business mailing address

155 N FRESNO STREET
FRESNO CA
93701
US

V. Phone/Fax

Practice location:
  • Phone: 408-320-8057
  • Fax: 415-413-2068
Mailing address:
  • Phone: 559-499-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A19518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: