Healthcare Provider Details

I. General information

NPI: 1265078778
Provider Name (Legal Business Name): HARMAN RANDHAWA RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39159 PASEO PADRE PKWY
FREMONT CA
94538-1608
US

IV. Provider business mailing address

39159 PASEO PADRE PKWY
FREMONT CA
94538-1608
US

V. Phone/Fax

Practice location:
  • Phone: 855-249-3663
  • Fax:
Mailing address:
  • Phone: 855-249-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95012810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: