Organization Name: | AMRITPAL PANNU, MD |
NPI Number: | 1598183238 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA HAWTHORNE (MANAGER) |
Mailing Address: | 129 N 5th St Chowchilla |
State: | CA US |
Postal Code: | 936102820 |
Phone Number: | 5596650275 |
Fax Number: | 5596657126 |
NPI Enumeration Date: | 03/31/2014 |
NPI Last Update Date: | 06/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | A62711 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |