Healthcare Provider Details

I. General information

NPI: 1639335268
Provider Name (Legal Business Name): AANMOL INDERJEET KAUR RAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78140 CALLE TAMPICO
LA QUINTA CA
92253-2900
US

IV. Provider business mailing address

78140 CALLE TAMPICO
LA QUINTA CA
92253-2900
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-7970
  • Fax:
Mailing address:
  • Phone: 760-863-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD434732
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA113881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: