Provider Demographics
NPI:1205358819
Name:GHAG, JETINDER SINGH
Entity Type:Individual
Prefix:
First Name:JETINDER
Middle Name:SINGH
Last Name:GHAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9429 N PAULA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4482
Mailing Address - Country:US
Mailing Address - Phone:559-704-7231
Mailing Address - Fax:
Practice Address - Street 1:3636 N.FIRST ST # 135 AND 154
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-225-1464
Practice Address - Fax:844-601-2973
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)