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General NPI Number Information
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NPI Number | 1194151704
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Entity Type | Individual
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Provider Name | HARINDER JHATU PA
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Gender | Male
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 2218 W WHITMORE AVE
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City | MODESTO
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State | CA
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Zip | 95358-9497
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Country | US
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Telephone | 209-818-3414
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 W WHITMORE AVE
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City | MODESTO
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State | CA
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Zip | 95358-9497
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Country | US
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Telephone | 209-818-3414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA23215
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License Number State | CA
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