Healthcare Provider Details

I. General information

NPI: 1699413880
Provider Name (Legal Business Name): PUNEET KAUR NIJJAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 11TH ST
ORANGE COVE CA
93646-2211
US

IV. Provider business mailing address

445 11TH ST
ORANGE COVE CA
93646-2211
US

V. Phone/Fax

Practice location:
  • Phone: 559-626-4963
  • Fax: 559-626-4963
Mailing address:
  • Phone: 559-626-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95021066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: