Basic Information
| Provider Information | |||||||||
| NPI: | 1144944646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHALIWAL | ||||||||
| FirstName: | KAWALPREET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 632 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907314112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056184665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 LOMITA BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105463461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XP0019X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225X00000X | 22626 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 22626 | 01 | CA | CALIFORNIA BOARD OF OCCUPATIONAL THERAPY | OTHER |