Provider Demographics
NPI:1558435453
Name:SIDHU, PRITPAL
Entity Type:Individual
Prefix:MS
First Name:PRITPAL
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 1:31604 W NINE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2955
Mailing Address - Country:US
Mailing Address - Phone:714-612-9977
Mailing Address - Fax:949-234-9762
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:#500
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3640
Practice Address - Country:US
Practice Address - Phone:714-480-6600
Practice Address - Fax:714-568-4527
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health