Basic Information
| Provider Information | |||||||||
| NPI: | 1285361014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASRAN | ||||||||
| FirstName: | RAJDEEP | ||||||||
| MiddleName: | KAUR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5467 E EUGENIA AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937276382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034709516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2021 HERNDON AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597974315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95022083 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.