MEDICARE: DR. SIMRAN DISABAR DNP, FNP

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	363L00000X	Nurse Practitioner	95171191	CA

General Provider Information

NPI Number	:	1962116103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMRAN DISABAR DNP, FNP

Provider Business Mailing Address
First Line	:	PO BOX 28292
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94604-8292
Country	:	US
Telephone Number	:	510-407-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 RITCHIE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-3329
Country	:	US
Telephone Number	:	510-407-8900
Fax Number	:

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

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/12/2023

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