Provider Demographics
NPI:1649332487
Name:PUAR, AMARJIT KAUR
Entity type:Individual
Prefix:
First Name:AMARJIT
Middle Name:KAUR
Last Name:PUAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2007
Mailing Address - Country:US
Mailing Address - Phone:323-734-4259
Mailing Address - Fax:
Practice Address - Street 1:1023 3RD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2007
Practice Address - Country:US
Practice Address - Phone:323-734-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALC79451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW7945Medicare ID - Type Unspecified