Healthcare Provider Details

I. General information

NPI: 1275247843
Provider Name (Legal Business Name): AMARBIR SINGH SANDHU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 N MILBURN AVE
FRESNO CA
93722-2155
US

IV. Provider business mailing address

2334 S EZIE AVE
FRESNO CA
93727-6065
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: