Provider Demographics
NPI:1194400598
Name:MANN, RAVINDER KAUR
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:KAUR
Last Name:MANN
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 1:697 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-9334
Mailing Address - Country:US
Mailing Address - Phone:559-514-2772
Mailing Address - Fax:
Practice Address - Street 1:32605 TEMECULA PKWY STE 220
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6839
Practice Address - Country:US
Practice Address - Phone:951-514-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health