1124328273 NPI number — SHIVINDER S. DEOL M.D., INC.

Table of content: (NPI 1124328273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124328273 NPI number — SHIVINDER S. DEOL M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIVINDER S. DEOL 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:
6
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:
1124328273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 STOCKDALE HWY
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309-2059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-325-7452
Provider Business Mailing Address Fax Number:
661-325-7456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 STOCKDALE HWY
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-325-7452
Provider Business Practice Location Address Fax Number:
661-325-7456
Provider Enumeration Date:
10/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DEOL
Authorized Official First Name:
SHIVINDER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-325-7452

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A37723 , 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)

  • Identifier: 080004729 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84411017 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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