Healthcare Provider Details

I. General information

NPI: 1487565917
Provider Name (Legal Business Name): INDERPREET KAUR GREWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12372 MESA ROJO WAY
VICTORVILLE CA
92392-8721
US

IV. Provider business mailing address

12372 MESA ROJO WAY
VICTORVILLE CA
92392-8721
US

V. Phone/Fax

Practice location:
  • Phone: 951-255-6533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: