Healthcare Provider Details

I. General information

NPI: 1275948952
Provider Name (Legal Business Name): MANJINDER KAUR UPPAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 270
SACRAMENTO CA
95816-5173
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD STE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-455-3700
  • Fax: 916-733-8232
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A17338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: