Provider Demographics
NPI:1629543343
Name:SANDHU, MANRAJ KAUR (NP)
Entity type:Individual
Prefix:
First Name:MANRAJ
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MANRAJ
Other - Middle Name:KAUR
Other - Last Name:PADDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-482-7623
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:1508 ALHAMBRA BLVD # 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6510
Practice Address - Country:US
Practice Address - Phone:916-325-1040
Practice Address - Fax:916-771-8515
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner