Healthcare Provider Details

I. General information

NPI: 1194436733
Provider Name (Legal Business Name): JATINDER S PRUTHI, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W STE 209
LANCASTER CA
93534-5504
US

IV. Provider business mailing address

44215 15TH ST W STE 209
LANCASTER CA
93534-5504
US

V. Phone/Fax

Practice location:
  • Phone: 661-435-9746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JATINDER S PRUTHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-435-9746