Provider Demographics
NPI:1902495641
Name:KAUR, PRABHJOT (RN)
Entity Type:Individual
Prefix:
First Name:PRABHJOT
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 PICARDY PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1485
Mailing Address - Country:US
Mailing Address - Phone:626-400-0298
Mailing Address - Fax:
Practice Address - Street 1:16615 PICARDY PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1485
Practice Address - Country:US
Practice Address - Phone:626-400-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95174770163WM0705X
CA559456163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical