Healthcare Provider Details

I. General information

NPI: 1548008089
Provider Name (Legal Business Name): NEHADEEP K DHALIWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2892 PIXLEY CT
MANTECA CA
95337-7279
US

IV. Provider business mailing address

2892 PIXLEY CT
MANTECA CA
95337-7279
US

V. Phone/Fax

Practice location:
  • Phone: 209-880-9317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95322563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: