Basic Information
| Provider Information | |||||||||
| NPI: | 1811378128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAR | ||||||||
| FirstName: | RAJDEEP | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SINGH | ||||||||
| OtherFirstName: | RAJDEEP | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 78120 WILDCAT DR | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922111140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603402682 | ||||||||
| FaxNumber: | 7607739695 | ||||||||
| Practice Location | |||||||||
| Address1: | 45280 SEELEY DR | ||||||||
| Address2: | |||||||||
| City: | LA QUINTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922536834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608347920 | ||||||||
| FaxNumber: | 7608347921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A152466 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.