Provider Demographics
NPI:1083259899
Name:SANDHU, GAGANJIT (FNP)
Entity Type:Individual
Prefix:
First Name:GAGANJIT
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORTONA WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7124
Mailing Address - Country:US
Mailing Address - Phone:925-926-0195
Mailing Address - Fax:
Practice Address - Street 1:100 CORTONA WAY STE 160
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7157
Practice Address - Country:US
Practice Address - Phone:925-926-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA828947163WE0003X
CA95013758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency