Provider Demographics
NPI:1073329736
Name:ATWAL, MANREET S
Entity type:Individual
Prefix:
First Name:MANREET
Middle Name:S
Last Name:ATWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4711
Mailing Address - Country:US
Mailing Address - Phone:209-663-5776
Mailing Address - Fax:
Practice Address - Street 1:2087 HOLT DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4812
Practice Address - Country:US
Practice Address - Phone:209-663-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage