Provider Demographics
NPI:1710089578
Name:SANDHU, HARSIMRAT (MD)
Entity Type:Individual
Prefix:
First Name:HARSIMRAT
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CORPORATE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2180
Mailing Address - Country:US
Mailing Address - Phone:949-768-2988
Mailing Address - Fax:
Practice Address - Street 1:3802 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5032
Practice Address - Country:US
Practice Address - Phone:425-259-6665
Practice Address - Fax:425-259-6014
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG787072084P0800X
WAMD00030499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#
CAFHC 70044FOtherSANTA CRUZ COUNTY CA MEDI-CAL SITE #
CAZZZ91891ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#
CAFHC 70042FOtherSANTA CRUZ COUNTY CA MEDI-CAL SITE #
CAZZZ91892ZOtherSANTA CRUZ COUNTY CA MEDICARE GROUP PTAN#
CAG78707OtherPHYSICIAN AND SURGEON#
CAG78707OtherPHYSICIAN AND SURGEON#