Basic Information
Provider Information
NPI: 1972249662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAUR
FirstName: GULNEET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 COFFEE RD
Address2:  
City: MODESTO
State: CA
PostalCode: 953554201
CountryCode: US
TelephoneNumber: 2095241211
FaxNumber:  
Practice Location
Address1: 1409 E BRIGGSMORE AVE
Address2:  
City: MODESTO
State: CA
PostalCode: 953552707
CountryCode: US
TelephoneNumber: 2095504750
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/06/2022
LastUpdateDate: 06/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X95020881CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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