Healthcare Provider Details

I. General information

NPI: 1174655401
Provider Name (Legal Business Name): DR. INDERJIT SINGH GREWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C.T.F. 5 MILES N OF SOLEDAD
SOLEDAD CA
93960-0686
US

IV. Provider business mailing address

PO BOX 686
SOLEDAD CA
93960-0686
US

V. Phone/Fax

Practice location:
  • Phone: 831-678-5982
  • Fax: 831-678-5908
Mailing address:
  • Phone: 831-678-5982
  • Fax: 831-678-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-36452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: