MEDICARE: GURPREET MANDAIR

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1326604414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURPREET MANDAIR

Provider Business Mailing Address
First Line	:	615 N 17TH ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-3029
Country	:	US
Telephone Number	:	408-858-0487
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 N 17TH ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-3029
Country	:	US
Telephone Number	:	408-858-0487
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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Directions to “ GURPREET MANDAIR ” Practice Location

Language	Start Address	Practice Location

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