Healthcare Provider Details

I. General information

NPI: 1992356844
Provider Name (Legal Business Name): KARAMJEET KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 EL PORTAL DR
SAN PABLO CA
94806-3305
US

IV. Provider business mailing address

1006 LAVENDER PL
HERCULES CA
94547-2006
US

V. Phone/Fax

Practice location:
  • Phone: 510-215-3700
  • Fax: 510-215-3751
Mailing address:
  • Phone: 510-200-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95150833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: