Provider Demographics
NPI:1104879956
Name:SINGH, AMANDEEP (MD)
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:SINGH
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 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:345 SPRING ST
Practice Address - Street 2:STE# 101
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3168
Practice Address - Country:US
Practice Address - Phone:805-238-7250
Practice Address - Fax:805-238-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124045042OtherCHCCC, PASO ROBLES NPI
CAFHC70737FMedicaid
CABF443ZMedicare PIN
CA1275553257Medicare PIN
CAW1508EMedicare PIN
CAW1508Medicare PIN
CAWC52595AMedicare PIN
CA551905Medicare Oscar/Certification
CA1841217866Medicare PIN
CAI48014Medicare UPIN
CAFHC70737FMedicaid