Healthcare Provider Details

I. General information

NPI: 1710349683
Provider Name (Legal Business Name): NIRMAL S. BRAR M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 12/09/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E HERNDON AVE STE 115
FRESNO CA
93720-3100
US

IV. Provider business mailing address

1111 E HERNDON AVE STE 115
FRESNO CA
93720-3100
US

V. Phone/Fax

Practice location:
  • Phone: 559-376-7921
  • Fax: 559-336-4176
Mailing address:
  • Phone: 559-376-7921
  • Fax: 559-336-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NIRMAL BRAR
Title or Position: PRESIDENT
Credential:
Phone: 559-376-7921