Healthcare Provider Details

I. General information

NPI: 1801955646
Provider Name (Legal Business Name): RAVINDER KAUR SAHOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

210 FOOTHILL DR
VALLEJO CA
94591-3661
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2072
  • Fax:
Mailing address:
  • Phone: 707-552-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: