Provider Demographics
NPI:1639206824
Name:KHALSA, DAVI KAUR (CNM)
Entity Type:Individual
Prefix:
First Name:DAVI
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1454
Practice Address - Country:US
Practice Address - Phone:310-278-6333
Practice Address - Fax:310-278-4329
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANM1573367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife