Healthcare Provider Details

I. General information

NPI: 1376471565
Provider Name (Legal Business Name): SUKHDEEP DHALIWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 N VIA CAMPAGNA DR
FRESNO CA
93730-8878
US

IV. Provider business mailing address

11515 N VIA CAMPAGNA DR
FRESNO CA
93730-8878
US

V. Phone/Fax

Practice location:
  • Phone: 559-708-3265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95217421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: