Healthcare Provider Details

I. General information

NPI: 1700840188
Provider Name (Legal Business Name): AMARJIT S GREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE MAIN JAIL PSYCHIATRY UNIT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

759 SUNSET GLEN DR
SAN JOSE CA
95123-4544
US

V. Phone/Fax

Practice location:
  • Phone: 408-299-8757
  • Fax:
Mailing address:
  • Phone: 408-224-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA37895
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA37895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: