Healthcare Provider Details

I. General information

NPI: 1528905288
Provider Name (Legal Business Name): KAWALPREET KAUR GREWAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CARRILLO DR STE 300
LOS ANGELES CA
90048-5475
US

IV. Provider business mailing address

3051 W AVENUE M2
LANCASTER CA
93536-2839
US

V. Phone/Fax

Practice location:
  • Phone: 424-258-0124
  • Fax:
Mailing address:
  • Phone: 661-435-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: