Provider Demographics
NPI:1770985798
Name:MAHAL, JASKAREN
Entity type:Individual
Prefix:
First Name:JASKAREN
Middle Name:
Last Name:MAHAL
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 1:820 E STATE HIGHWAY 88 STE 700
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2134
Mailing Address - Country:US
Mailing Address - Phone:209-223-7040
Mailing Address - Fax:209-223-7606
Practice Address - Street 1:820 E STATE HIGHWAY 88 STE 700
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2134
Practice Address - Country:US
Practice Address - Phone:209-223-7040
Practice Address - Fax:209-223-7606
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95025582363LF0000X
CA95025582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily