Provider Demographics
NPI:1366435448
Name:DEOL, RUPINDER M (ARNP)
Entity type:Individual
Prefix:
First Name:RUPINDER
Middle Name:M
Last Name:DEOL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RUPINDER
Other - Middle Name:
Other - Last Name:MANGATDEOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:3100 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3866
Practice Address - Country:US
Practice Address - Phone:916-774-8300
Practice Address - Fax:916-774-8383
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005798163WM0705X
CANP19510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0197476OtherL&I
WA9644386Medicaid
WAS97654Medicare UPIN
WA9644386Medicaid
WA0197476OtherL&I