Basic Information
| Provider Information | |||||||||
| NPI: | 1033391024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCELLENCE IN HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 RAILROAD AVE. | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960012504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302431414 | ||||||||
| FaxNumber: | 5302430493 | ||||||||
| Practice Location | |||||||||
| Address1: | 2110 RAILROAD AVE. | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960012504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302431414 | ||||||||
| FaxNumber: | 5302430493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | GURPREET | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5302431414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O., PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A7738 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX77380 | 05 | CA | MEDICAID |