Provider Demographics
NPI:1871327825
Name:KHALSA, JUVENTINA MARIA
Entity type:Individual
Prefix:
First Name:JUVENTINA
Middle Name:MARIA
Last Name:KHALSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03861-6511
Mailing Address - Country:US
Mailing Address - Phone:858-213-8263
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW ENGLAND
Practice Address - Street 2:716 STEVENS AVENUE
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-221-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program