Healthcare Provider Details

I. General information

NPI: 1629709241
Provider Name (Legal Business Name): MANPREET DHANOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MARCONI AVE
SACRAMENTO CA
95821-1506
US

IV. Provider business mailing address

7817 OCEAN PARK DR
ANTELOPE CA
95843-4334
US

V. Phone/Fax

Practice location:
  • Phone: 916-751-8052
  • Fax:
Mailing address:
  • Phone: 916-751-8052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: