Basic Information
| Provider Information | |||||||||
| NPI: | 1407297146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | JASPREET | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 W AVENUE M4 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935511432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614802377 | ||||||||
| FaxNumber: | 6614802378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 W AVENUE M4 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935511432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614802377 | ||||||||
| FaxNumber: | 6614802378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 56514 | AZ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0014X | 56514 | AZ | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | 56514 | AZ | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 393248 | 05 | AZ | MEDICAID |