Provider Demographics
NPI:1093018269
Name:DHALIWAL, JASPAL S (MD)
Entity type:Individual
Prefix:
First Name:JASPAL
Middle Name:S
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASPAL
Other - Middle Name:S
Other - Last Name:UMRANANGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2801 SANTA MARIA WAY #A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:97304-1073
Mailing Address - Country:US
Mailing Address - Phone:805-938-9200
Mailing Address - Fax:
Practice Address - Street 1:2801 SANTA MARIA WAY # A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2118
Practice Address - Country:US
Practice Address - Phone:805-938-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105383208D00000X
WA00044710208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
143809Medicare UPIN
8856693Medicare PIN