Healthcare Provider Details

I. General information

NPI: 1790913812
Provider Name (Legal Business Name): MIKE SINGH DHALIWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

11216 WOODMAR LN NE
ALBUQUERQUE NM
87111-6509
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5000
  • Fax: 661-949-5971
Mailing address:
  • Phone: 714-651-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA108561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: