Provider Demographics
NPI:1467654285
Name:SIDHU, MANPREET
Entity Type:Individual
Prefix:MS
First Name:MANPREET
Middle Name:
Last Name:SIDHU
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 1:1200 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-226-6667
Mailing Address - Fax:323-226-5760
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-6667
Practice Address - Fax:323-226-5760
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16851363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW809BMedicare ID - Type UnspecifiedHUDSON
CAW932Medicare ID - Type UnspecifiedHEALTH CENTERS
CAW809AMedicare ID - Type UnspecifiedROYBAL