Healthcare Provider Details

I. General information

NPI: 1760558332
Provider Name (Legal Business Name): JAGDEEP KAUR MEHROK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17284 SLOVER AVE
FONTANA CA
92337-7584
US

IV. Provider business mailing address

17284 SLOVER AVE
FONTANA CA
92337-7584
US

V. Phone/Fax

Practice location:
  • Phone: 909-609-3000
  • Fax:
Mailing address:
  • Phone: 909-609-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD226328
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70009596
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: