Individual
JASLEEN KAUR DHALIWAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1205 E NORTH ST, MANTECA, CA 95336-4900
(951) 973-2033
Mailing address
1205 E NORTH ST, MANTECA, CA 95336-4900
(951) 973-2033
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
1093246779
CA
282N00000X
General Acute Care Hospital
Primary
95005648
CA
363LF0000X
Family Nurse Practitioner
95005648
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093246779
—
CA
Enumeration date
03/23/2017
Last updated
04/26/2021
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