=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689440406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASPAL DHANJAL ND
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2023
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3521 LEONARD CT STE C
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-878-9746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2998 DELEGATE DR
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95648-6355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 1453
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------