=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295433878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WIRSA WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 W YOSEMITE AVE
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95336-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-650-0911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1169 S MAIN ST # 184
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95337-5747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-661-9528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP/FNP
-----------------------------------------------------
Name | HARPREET KAUR JOHL
-----------------------------------------------------
Credential | PMHNP/FNP
-----------------------------------------------------
Telephone | 209-650-0911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------