Provider Demographics
NPI:1740051622
Name:NIRWAL, GAGANDEEP SINGH
Entity type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:NIRWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 TRAMORE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4259
Mailing Address - Country:US
Mailing Address - Phone:209-601-2176
Mailing Address - Fax:
Practice Address - Street 1:10931 TRAMORE LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4259
Practice Address - Country:US
Practice Address - Phone:209-601-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137137163W00000X
CA95002570367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse