1154633527 NPI number — JASBIR S. TIWANA M.D INC

Table of content: (NPI 1154633527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154633527 NPI number — JASBIR S. TIWANA M.D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASBIR S. TIWANA M.D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154633527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060-D E AVENIDA DE LOS ARBOLES STE 765
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91362-1376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-990-0439
Provider Business Mailing Address Fax Number:
805-512-7265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1172 SWALLOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93065-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-278-5590
Provider Business Practice Location Address Fax Number:
951-272-9924
Provider Enumeration Date:
07/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TIWANA
Authorized Official First Name:
JASBIR
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
805-583-4111

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A105298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)