Provider Demographics
NPI:1528405313
Name:RANDHAWA, HARBHAJAN KAUR
Entity Type:Individual
Prefix:
First Name:HARBHAJAN
Middle Name:KAUR
Last Name:RANDHAWA
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 1:9353 N ARCHIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1443
Mailing Address - Country:US
Mailing Address - Phone:559-492-1612
Mailing Address - Fax:
Practice Address - Street 1:9353 N ARCHIE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1443
Practice Address - Country:US
Practice Address - Phone:559-492-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6990540Medicare PIN