Healthcare Provider Details

I. General information

NPI: 1083352744
Provider Name (Legal Business Name): SUNMEET KAUR CHAWLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 116
LOS ANGELES CA
90025-2586
US

IV. Provider business mailing address

PO BOX 10818
SAN BERNARDINO CA
92423-0818
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-8084
  • Fax: 909-495-1301
Mailing address:
  • Phone: 909-382-0201
  • Fax: 909-495-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95020287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95020287
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95266217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: