Provider Demographics
NPI:1376213793
Name:KAUR, MANDEEP (NP)
Entity type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DRIVE
Mailing Address - Street 2:BUILDING 1, SUITE #105
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3021
Mailing Address - Country:US
Mailing Address - Phone:619-724-6644
Mailing Address - Fax:909-265-9407
Practice Address - Street 1:5565 GROSSMONT CENTER DRIVE
Practice Address - Street 2:BUILDING 1, SUITE #105
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3021
Practice Address - Country:US
Practice Address - Phone:619-724-6644
Practice Address - Fax:909-265-9407
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner