Healthcare Provider Details

I. General information

NPI: 1073855268
Provider Name (Legal Business Name): SANDEEP KAUR JOUHAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR #9116A
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

9500 GILMAN DR #9116A
LA JOLLA CA
92093-5004
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax: 858-822-0231
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number139211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: