Healthcare Provider Details

I. General information

NPI: 1982186508
Provider Name (Legal Business Name): HARDEEP MUNDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9792 LIVE OAK BLVD STE E
LIVE OAK CA
95953-2381
US

IV. Provider business mailing address

9792 LIVE OAK BLVD STE E
LIVE OAK CA
95953-2381
US

V. Phone/Fax

Practice location:
  • Phone: 530-701-3131
  • Fax: 530-237-0460
Mailing address:
  • Phone: 530-701-3131
  • Fax: 530-237-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: