Provider Demographics
NPI:1780719450
Name:SINGH, AMARJIT
Entity type:Individual
Prefix:MR
First Name:AMARJIT
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4623
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-0623
Mailing Address - Country:US
Mailing Address - Phone:209-469-4817
Mailing Address - Fax:209-465-1635
Practice Address - Street 1:2216 N CALIFORNIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5533
Practice Address - Country:US
Practice Address - Phone:209-469-4817
Practice Address - Fax:209-465-1635
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101442332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01062GMedicaid
CA4567240001Medicare NSC