Provider Demographics
NPI:1164530440
Name:AHLUWALIA, TREVINDER (MD)
Entity Type:Individual
Prefix:MRS
First Name:TREVINDER
Middle Name:
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16143 KOKANEE RD
Mailing Address - Street 2:#A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1355
Mailing Address - Country:US
Mailing Address - Phone:760-242-9577
Mailing Address - Fax:
Practice Address - Street 1:16143 KOKANEE RD
Practice Address - Street 2:STE A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1355
Practice Address - Country:US
Practice Address - Phone:760-242-9579
Practice Address - Fax:760-242-2213
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA382992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0334017Medicaid
CA0334017Medicaid
A382990Medicare ID - Type Unspecified