Healthcare Provider Details

I. General information

NPI: 1295308740
Provider Name (Legal Business Name): GAGANDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

1235 E ST
FRESNO CA
93706-2024
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7100
  • Fax:
Mailing address:
  • Phone: 559-268-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN274873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: