Healthcare Provider Details

I. General information

NPI: 1174271563
Provider Name (Legal Business Name): RITU RAJBIR CHAWLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 S AUBURN ST STE C2
GRASS VALLEY CA
95945-4318
US

IV. Provider business mailing address

536 WHITING ST APT 9
GRASS VALLEY CA
95945-7557
US

V. Phone/Fax

Practice location:
  • Phone: 916-787-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: