Healthcare Provider Details

I. General information

NPI: 1811810476
Provider Name (Legal Business Name): RAJVIR KAUR SANDHU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 EUREKA RD STE 103
ROSEVILLE CA
95661-3047
US

IV. Provider business mailing address

PO BOX 154 6330 FOUNTAIN SQUARE DR
CITRUS HEIGHTS CA
95611-0154
US

V. Phone/Fax

Practice location:
  • Phone: 916-772-5325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: