Healthcare Provider Details

I. General information

NPI: 1871918854
Provider Name (Legal Business Name): MR. BIMALDEEP GOSAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 NAOMI WAY
SACRAMENTO CA
95815-1938
US

IV. Provider business mailing address

1922 NAOMI WAY
SACRAMENTO CA
95815-1938
US

V. Phone/Fax

Practice location:
  • Phone: 916-296-7574
  • Fax: 916-258-0929
Mailing address:
  • Phone: 916-296-7574
  • Fax: 916-258-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: