Provider Demographics
NPI:1033979943
Name:DHARIWAL, SAMREEN KAUR
Entity Type:Individual
Prefix:
First Name:SAMREEN
Middle Name:KAUR
Last Name:DHARIWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 ATTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6440
Mailing Address - Country:US
Mailing Address - Phone:818-804-9770
Mailing Address - Fax:
Practice Address - Street 1:2928 ATTERBURY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6440
Practice Address - Country:US
Practice Address - Phone:818-804-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant