Basic Information
| Provider Information | |||||||||
| NPI: | 1720658305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMRA | ||||||||
| FirstName: | HARKARAN | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2163 ACKERMAN DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945654651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256985200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13585 SAN PABLO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN PABLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109424700 | ||||||||
| FaxNumber: | 5102153720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 95214363 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.