Healthcare Provider Details

I. General information

NPI: 1508624255
Provider Name (Legal Business Name): MANMEET KAUR RANDHAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N STATE ST
HEMET CA
92543-1474
US

IV. Provider business mailing address

1003 N STATE ST
HEMET CA
92543-1474
US

V. Phone/Fax

Practice location:
  • Phone: 661-432-8697
  • Fax:
Mailing address:
  • Phone: 951-652-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95131947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: