Healthcare Provider Details

I. General information

NPI: 1154047181
Provider Name (Legal Business Name): GAVNEET UPPAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 LA JOLLA VILLAGE DR STE 1212
SAN DIEGO CA
92122-1494
US

IV. Provider business mailing address

1213 AMERICAN AVE
PLAINFIELD IN
46168-3268
US

V. Phone/Fax

Practice location:
  • Phone: 619-894-9582
  • Fax:
Mailing address:
  • Phone: 317-410-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030427
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013180A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28244838A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95374146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: