MEDICARE: PAVITTAR KAUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235609892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVITTAR KAUR

Provider Business Mailing Address
First Line	:	3620 W HAMMER LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-5532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 TAM O SHANTER DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3370
Country	:	US
Telephone Number	:	209-521-4791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	01/09/2026

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Directions to “ PAVITTAR KAUR ” Practice Location

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