Provider Demographics
NPI:1932462124
Name:SANDHU, GURPREET (OTR)
Entity Type:Individual
Prefix:
First Name:GURPREET
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 311. 2488 KELLY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT COQUITLAM
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T6R3S2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 311, 2488 KELLY AVENUE
Practice Address - Street 2:
Practice Address - City:PORT COQUITLAM
Practice Address - State:ALBERTA
Practice Address - Zip Code:V3C 1Y4
Practice Address - Country:CA
Practice Address - Phone:778-378-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor