Healthcare Provider Details

I. General information

NPI: 1497951974
Provider Name (Legal Business Name): PARDEEP S. BHULLAR MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 N PALM AVE STE 101
FRESNO CA
93711-5782
US

IV. Provider business mailing address

1975 N JASMINE AVE
CLOVIS CA
93619-2801
US

V. Phone/Fax

Practice location:
  • Phone: 559-696-8046
  • Fax:
Mailing address:
  • Phone: 559-696-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA615370
License Number StateCA

VIII. Authorized Official

Name: DR. PARDEEP S. BHULLAR
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 559-696-8046