Provider Demographics
NPI:1073194940
Name:PREET, KOMAL
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:PREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17234 VALLEY BLVD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:833-574-2273
Mailing Address - Fax:
Practice Address - Street 1:2335 172ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4753
Practice Address - Country:US
Practice Address - Phone:360-651-1550
Practice Address - Fax:877-516-9924
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61591586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine