Healthcare Provider Details

I. General information

NPI: 1710706916
Provider Name (Legal Business Name): AVNEET KAUR VIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

43236 CAROL DR
LANCASTER CA
93535-4929
US

V. Phone/Fax

Practice location:
  • Phone: 661-547-9365
  • Fax:
Mailing address:
  • Phone: 661-547-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95030023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: