Healthcare Provider Details

I. General information

NPI: 1770464018
Provider Name (Legal Business Name): JASPINDER SINGH BRAICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E. KINGS CANYON RD
FRESNO CA
93702
US

IV. Provider business mailing address

4411 E. KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-1008
  • Fax:
Mailing address:
  • Phone: 559-453-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95429572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: