Healthcare Provider Details

I. General information

NPI: 1104700996
Provider Name (Legal Business Name): MANKAMAL DOSANJH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 HIGHLAND AVE
SELMA CA
93662-3389
US

IV. Provider business mailing address

2705 HIGHLAND AVE
SELMA CA
93662-3389
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: