Provider Demographics
NPI: | 1174842942 |
---|---|
Name: | APNA HEALTH CLINIC INC |
Entity type: | Organization |
Organization Name: | APNA HEALTH CLINIC INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GURDAVER |
Authorized Official - Middle Name: | SINGH |
Authorized Official - Last Name: | DHALIWAL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 559-246-3670 |
Mailing Address - Street 1: | 1555 SHAW AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CLOVIS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93611-4096 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 559-246-3670 |
Mailing Address - Fax: | 559-324-7033 |
Practice Address - Street 1: | 1555 SHAW AVE |
Practice Address - Street 2: | |
Practice Address - City: | CLOVIS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93611-4096 |
Practice Address - Country: | US |
Practice Address - Phone: | 559-246-3670 |
Practice Address - Fax: | 559-324-7033 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-05-19 |
Last Update Date: | 2018-05-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A101525 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |