Provider Demographics
NPI:1366645616
Name:KOHLI, NEELU (MD)
Entity Type:Individual
Prefix:
First Name:NEELU
Middle Name:
Last Name:KOHLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEELU
Other - Middle Name:
Other - Last Name:KOHLI MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17264 FOOTHILL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-9050
Mailing Address - Country:US
Mailing Address - Phone:909-823-0000
Mailing Address - Fax:
Practice Address - Street 1:17264 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9050
Practice Address - Country:US
Practice Address - Phone:909-823-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87993208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
050167Medicare PIN
103184Medicare UPIN