Healthcare Provider Details

I. General information

NPI: 1659902658
Provider Name (Legal Business Name): JARNAIL SINGH SANDHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date: 02/05/2021
Reactivation Date: 03/08/2021

III. Provider practice location address

130 W GABILAN ST
SALINAS CA
93901-2762
US

IV. Provider business mailing address

PO BOX 191
SALINAS CA
93902-0191
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-0181
  • Fax:
Mailing address:
  • Phone: 559-898-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: