Provider Demographics
NPI:1235687591
Name:SINGH, TIRLOK KAPOOR
Entity Type:Individual
Prefix:
First Name:TIRLOK
Middle Name:KAPOOR
Last Name:SINGH
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 1:4119 CORONADO AVE
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-2336
Mailing Address - Country:US
Mailing Address - Phone:209-462-4163
Mailing Address - Fax:209-462-4165
Practice Address - Street 1:4119 CORONADO AVE
Practice Address - Street 2:SUITE # 9
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2336
Practice Address - Country:US
Practice Address - Phone:209-462-4163
Practice Address - Fax:209-462-4165
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor