Provider Demographics
NPI:1225800568
Name:NIJJRAH, SUKHMEET
Entity Type:Individual
Prefix:
First Name:SUKHMEET
Middle Name:
Last Name:NIJJRAH
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 1:17077 CRABAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-6871
Mailing Address - Country:US
Mailing Address - Phone:424-666-5043
Mailing Address - Fax:
Practice Address - Street 1:17077 CRABAPPLE LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-6871
Practice Address - Country:US
Practice Address - Phone:424-666-5043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1463258207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services