Healthcare Provider Details

I. General information

NPI: 1346843828
Provider Name (Legal Business Name): JASPREET KAUR BHANGU LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 S BARTON AVE
FRESNO CA
93702-2985
US

IV. Provider business mailing address

496 S BARTON AVE
FRESNO CA
93702-2985
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-4422
  • Fax: 559-475-7866
Mailing address:
  • Phone: 559-860-4422
  • Fax: 559-475-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN710287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberVN710287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: