Healthcare Provider Details

I. General information

NPI: 1659423093
Provider Name (Legal Business Name): SURJIT KAUR NIJJAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 TOWN CENTER PLZ STE G130
WEST SACRAMENTO CA
95691-5058
US

IV. Provider business mailing address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5547
  • Fax:
Mailing address:
  • Phone: 916-423-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: