Provider Demographics
NPI:1558081067
Name:KHOSA, BALWINDER SINGH
Entity Type:Individual
Prefix:
First Name:BALWINDER
Middle Name:SINGH
Last Name:KHOSA
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 1:2166 BRIGADE AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8049
Mailing Address - Country:US
Mailing Address - Phone:510-513-9625
Mailing Address - Fax:
Practice Address - Street 1:2166 BRIGADE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8049
Practice Address - Country:US
Practice Address - Phone:510-513-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst