Healthcare Provider Details

I. General information

NPI: 1235906967
Provider Name (Legal Business Name): RANJIT SINGH AULAKH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST STE A
MARINA CA
93933-6003
US

IV. Provider business mailing address

299 12TH ST STE A
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax: 831-647-7940
Mailing address:
  • Phone: 831-647-7652
  • Fax: 831-647-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: