Healthcare Provider Details

I. General information

NPI: 1801479787
Provider Name (Legal Business Name): MANINDER KAUR JASDHAUL MSN,RN,ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 16TH ST
SANTA MONICA CA
90404-1249
US

IV. Provider business mailing address

15911 MCKEEVER ST
GRANADA HILLS CA
91344-3926
US

V. Phone/Fax

Practice location:
  • Phone: 213-440-0106
  • Fax:
Mailing address:
  • Phone: 213-440-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: