Provider Demographics
NPI:1023199783
Name:SALUJA, JASPREET (MD)
Entity type:Individual
Prefix:
First Name:JASPREET
Middle Name:
Last Name:SALUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-883-7400
Mailing Address - Fax:909-658-6443
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-883-7400
Practice Address - Fax:909-658-6443
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A780620Medicaid
CA00A780620Medicaid
CA00A780620Medicare PIN
CABS6595942OtherDEA NUMBER