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NPI 1144492455

NPI 1144492455 : KULJINDER S GREWAL M D PC : LA MESA, CA

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General NPI Number Information
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    NPI Number           |    1144492455
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    Entity Type          |    Organization 
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    Legal Business Name  |    KULJINDER S GREWAL M D PC 
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Dates
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    Enumeration Date     |    03/26/2008
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    Last Update Date     |    06/16/2010
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Provider Practice Location Address
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    Address Line         |    8881 FLETCHER PKWY SUITE 104
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    City                 |    LA MESA
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    State                |    CA
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    Zip                  |    91942-3134
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    Country              |    US
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    Telephone            |    619-644-1400
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    Fax                  |    619-644-1422
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Provider Business Mailing Address
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    Address Line         |    8881 FLETCHER PKWY SUITE 104
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    City                 |    LA MESA
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    State                |    CA
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    Zip                  |    91942-3134
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    Country              |    US
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    Telephone            |    619-644-1400
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    Fax                  |    619-644-1422
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Authorized Official
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    Title or Position    |    PRESIDENT
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    Name                 |    DR. KULJINDER SINGH GREWAL 
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    Credential           |    MD
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    Telephone            |    619-644-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    207W00000X
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    Taxonomy Name        |    Ophthalmology Physician
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    License Number       |    A34108
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    License Number State |    CA
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