Provider Demographics
NPI:1164013132
Name:BRAR, SUKHDEEP KAUR
Entity Type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:KAUR
Last Name:BRAR
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-0700
Mailing Address - Country:US
Mailing Address - Phone:951-658-2232
Mailing Address - Fax:
Practice Address - Street 1:255 N GILBERT ST BLDG B4
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4078
Practice Address - Country:US
Practice Address - Phone:951-652-0060
Practice Address - Fax:888-379-5652
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily