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General NPI Number Information
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NPI Number | 1801617527
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Entity Type | Individual
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Provider Name | PREM RANDALL SAHGAL JR. REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1161 E COVINA BLVD
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City | COVINA
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State | CA
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Zip | 91724-1523
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Country | US
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Telephone | 626-859-5277
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 W SHERWAY ST
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City | WEST COVINA
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State | CA
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Zip | 91790-2636
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Country | US
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Telephone |
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 622156
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 622156
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License Number State | CA
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