Healthcare Provider Details

I. General information

NPI: 1568786374
Provider Name (Legal Business Name): JASMINE KAUR ATWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 N CHESTNUT AVE STE 101
FRESNO CA
93720-0350
US

IV. Provider business mailing address

7055 N CHESTNUT AVE STE 101
FRESNO CA
93720-0350
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-0111
  • Fax: 559-298-0311
Mailing address:
  • Phone: 559-298-0111
  • Fax: 559-298-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA123075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA123075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: