Provider Demographics
NPI:1497114979
Name:KAUR, GULVARG
Entity Type:Individual
Prefix:
First Name:GULVARG
Middle Name:
Last Name:KAUR
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 1:7458 FREEPORT CIR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0707
Mailing Address - Country:US
Mailing Address - Phone:909-714-2119
Mailing Address - Fax:909-877-5675
Practice Address - Street 1:7458 FREEPORT CIR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0707
Practice Address - Country:US
Practice Address - Phone:909-714-2119
Practice Address - Fax:909-877-5675
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31040000X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility