Healthcare Provider Details

I. General information

NPI: 1871176594
Provider Name (Legal Business Name): GURINDER GOORY KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 02/03/2023
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 JACKSON ST
RIVERSIDE CA
92503-3901
US

IV. Provider business mailing address

16160 MARIPOSA AVE
RIVERSIDE CA
92504-8730
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-6889
  • Fax:
Mailing address:
  • Phone: 951-232-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95016862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: