Provider Demographics
NPI:1689871139
Name:MOHINDER & TREVINDER AHLUWALIA MD
Entity Type:Organization
Organization Name:MOHINDER & TREVINDER AHLUWALIA MD
Other - Org Name:MOHINDER & TREVINDER AHLUWALIA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHINDER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-9577
Mailing Address - Street 1:15982 QUANTICO RD STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1382
Mailing Address - Country:US
Mailing Address - Phone:760-242-9577
Mailing Address - Fax:760-242-4888
Practice Address - Street 1:15982 QUANTICO RD STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1382
Practice Address - Country:US
Practice Address - Phone:760-242-9577
Practice Address - Fax:760-242-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A382990Medicare PIN
CA00A384210Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER