Basic Information
| Provider Information | |||||||||
| NPI: | 1881197432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | SHELBEER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5157 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953525157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095722589 | ||||||||
| FaxNumber: | 2095721461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S AVENUE K | ||||||||
| Address2: | STATION 3, SHROC | ||||||||
| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755624232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2018 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 17-39235 | CA | N | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.