Provider Demographics
NPI:1154402683
Name:GURMEET S. MULATNI M.D. INC.
Entity type:Organization
Organization Name:GURMEET S. MULATNI M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GURMEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:MULTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-890-1411
Mailing Address - Street 1:1881 BUSINESS CENTER DR # 9
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3465
Mailing Address - Country:US
Mailing Address - Phone:909-890-1411
Mailing Address - Fax:909-890-1415
Practice Address - Street 1:1881 BUSINESS CENTER DR # 9
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-890-1411
Practice Address - Fax:909-890-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA048279Medicaid
CAF07156Medicare UPIN
CAA048279Medicaid