Healthcare Provider Details

I. General information

NPI: 1376063040
Provider Name (Legal Business Name): JASMEET KAUR TIWANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 WILLOW RD
MENLO PARK CA
94025-3653
US

IV. Provider business mailing address

4653 DELORES DR
UNION CITY CA
94587-5030
US

V. Phone/Fax

Practice location:
  • Phone: 866-839-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: