Healthcare Provider Details

I. General information

NPI: 1437819968
Provider Name (Legal Business Name): GURPREET KAUR TIWANA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/22/2023
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11783 CONNECTICUT DR
RANCHO CUCAMONGA CA
91730-8254
US

IV. Provider business mailing address

11783 CONNECTICUT DR
RANCHO CUCAMONGA CA
91730-8254
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-3939
  • Fax:
Mailing address:
  • Phone: 171-494-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCA95017157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: