Healthcare Provider Details

I. General information

NPI: 1124567904
Provider Name (Legal Business Name): MANPREET KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 FLETCHER LN
HAYWARD CA
94544-1008
US

IV. Provider business mailing address

795 FLETCHER LN
HAYWARD CA
94544-1008
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberVN247527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: