Healthcare Provider Details

I. General information

NPI: 1104984020
Provider Name (Legal Business Name): HARMEET SINGH BRAR PSYCH TECH, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4535
US

IV. Provider business mailing address

PO BOX 21
ATASCADERO CA
93423-0021
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4711
  • Fax: 805-781-4145
Mailing address:
  • Phone: 805-462-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number786001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number24970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: