=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437819968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GURPREET KAUR TIWANA NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2021
-----------------------------------------------------
Last Update Date | 12/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11783 CONNECTICUT DR
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-8254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-948-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11783 CONNECTICUT DR
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-8254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 171-494-8393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | CA95017157
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------