Healthcare Provider Details

I. General information

NPI: 1003154824
Provider Name (Legal Business Name): JASVIR K KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 CROWDER LN
ROSEVILLE CA
95747-9758
US

IV. Provider business mailing address

8383 CROWDER LN
ROSEVILLE CA
95747-9758
US

V. Phone/Fax

Practice location:
  • Phone: 916-257-7932
  • Fax:
Mailing address:
  • Phone: 916-257-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT00001392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: