Provider Demographics
NPI:1871918854
Name:GOSAL, BIMALDEEP
Entity type:Individual
Prefix:MR
First Name:BIMALDEEP
Middle Name:
Last Name:GOSAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 NAOMI WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1938
Mailing Address - Country:US
Mailing Address - Phone:916-296-7574
Mailing Address - Fax:916-258-0929
Practice Address - Street 1:1922 NAOMI WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1938
Practice Address - Country:US
Practice Address - Phone:916-296-7574
Practice Address - Fax:916-258-0929
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver