Provider Demographics
NPI:1851613483
Name:GREWAL, AJANAMJOT K (MD)
Entity Type:Individual
Prefix:
First Name:AJANAMJOT
Middle Name:K
Last Name:GREWAL
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:4231 US HIGHWAY 86
Practice Address - Street 2:SUITE 6
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-9648
Practice Address - Country:US
Practice Address - Phone:760-790-0005
Practice Address - Fax:760-344-7106
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA103791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEP487XMedicare PIN