Healthcare Provider Details

I. General information

NPI: 1568131811
Provider Name (Legal Business Name): GURPREET SINGH DHILLON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 E HARDING WAY
STOCKTON CA
95204-6101
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-546-5200
  • Fax: 209-466-1982
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95017056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: