Healthcare Provider Details

I. General information

NPI: 1528736444
Provider Name (Legal Business Name): GURSIMARN KAUR GREWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3894 E GETTYSBURG AVE
FRESNO CA
93726-0901
US

IV. Provider business mailing address

4460 W. SHAW AVE PMB 759
FRESNO CA
93722
US

V. Phone/Fax

Practice location:
  • Phone: 559-252-6844
  • Fax:
Mailing address:
  • Phone: 559-284-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: