Provider Demographics
NPI:1710963038
Name:DHILLON, MANPRIT K (MD)
Entity Type:Individual
Prefix:
First Name:MANPRIT
Middle Name:K
Last Name:DHILLON
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 1:42135 10TH ST W
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7095
Mailing Address - Country:US
Mailing Address - Phone:661-945-6931
Mailing Address - Fax:661-945-4592
Practice Address - Street 1:42135 10TH ST W
Practice Address - Street 2:SUITE # 301
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7095
Practice Address - Country:US
Practice Address - Phone:661-945-6931
Practice Address - Fax:661-945-4592
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75869207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A758690Medicaid
CA00A758690Medicaid
CAWA75869AMedicare ID - Type Unspecified
CAWA75869BMedicare ID - Type Unspecified