Provider Demographics
NPI:1770802159
Name:GREWAL, BERNEET KAUR (MD)
Entity type:Individual
Prefix:
First Name:BERNEET
Middle Name:KAUR
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-977-4639
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:7091 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1241
Practice Address - Country:US
Practice Address - Phone:520-721-5777
Practice Address - Fax:520-298-7231
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ53227207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1770802159OtherMEDICAID NUMBER