Provider Demographics
NPI:1104683564
Name:KAUR, KIRANPAL CARRANZA
Entity type:Individual
Prefix:
First Name:KIRANPAL
Middle Name:CARRANZA
Last Name:KAUR
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 1:7912 WEST LN STE 221
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3159
Mailing Address - Country:US
Mailing Address - Phone:209-373-2829
Mailing Address - Fax:
Practice Address - Street 1:7912 WEST LN STE 221
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3159
Practice Address - Country:US
Practice Address - Phone:209-373-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health