Provider Demographics
NPI:1114150703
Name:DHALIWAL, MANJOT KAUR (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MANJOT
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:655 S CENTRAL VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2790
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:661-459-1974
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant