Healthcare Provider Details

I. General information

NPI: 1700150125
Provider Name (Legal Business Name): MISS GURPREET KAUR TIWANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST 1060 WEST TOWER
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST 1060 WEST TOWER
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 323-217-3422
  • Fax:
Mailing address:
  • Phone: 323-217-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: