Provider Demographics
NPI:1154518363
Name:RIAR, SIMERJIT KAUR (PA)
Entity type:Individual
Prefix:
First Name:SIMERJIT
Middle Name:KAUR
Last Name:RIAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3012
Mailing Address - Country:US
Mailing Address - Phone:559-896-2624
Mailing Address - Fax:559-896-3235
Practice Address - Street 1:2511 LOGAN ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3012
Practice Address - Country:US
Practice Address - Phone:559-896-2624
Practice Address - Fax:559-896-3235
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19328OtherSTATE LIC