Provider Demographics
NPI:1962116103
Name:DISABAR, SIMRAN (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:SIMRAN
Middle Name:
Last Name:DISABAR
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28292
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94604-8292
Mailing Address - Country:US
Mailing Address - Phone:510-407-8900
Mailing Address - Fax:
Practice Address - Street 1:2731 RITCHIE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3329
Practice Address - Country:US
Practice Address - Phone:510-407-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner