Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 1093246779 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95005648 | CA |
NPI | 1093246779 |
---|---|
Provider Name | Jasleen Kaur Dhaliwal |
First Address | Manteca, CA 95336-4900 |
Second Address | Manteca, CA 95336-4900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093246779 | (05) | CA |