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General NPI Number Information
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NPI Number | 1376213793
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Entity Type | Individual
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Provider Name | MANDEEP KAUR NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DRIVE BUILDING 1, SUITE #105
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City | LA MESA
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State | CA
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Zip | 91942-3021
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Country | US
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Telephone | 619-724-6644
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Fax | 909-265-9407
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Provider Business Mailing Address
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Address Line | 5565 GROSSMONT CENTER DRIVE BUILDING 1, SUITE #105
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City | LA MESA
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State | CA
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Zip | 91942-3021
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Country | US
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Telephone | 619-724-6644
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Fax | 909-265-9407
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018568
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License Number State | CA
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