Provider Demographics
NPI:1194397117
Name:ATHWAL, GEET
Entity Type:Individual
Prefix:
First Name:GEET
Middle Name:
Last Name:ATHWAL
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 1:16172 SHELTERED CV E
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8898
Mailing Address - Country:US
Mailing Address - Phone:209-606-7733
Mailing Address - Fax:
Practice Address - Street 1:16172 SHELTERED CV E
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8898
Practice Address - Country:US
Practice Address - Phone:209-606-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95133475163W00000X
CA95002269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse