Provider Demographics
NPI:1982788204
Name:GREWAL, BALJINDER SINGH (PHD)
Entity type:Individual
Prefix:DR
First Name:BALJINDER
Middle Name:SINGH
Last Name:GREWAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20944 SHERMAN WAY STE 109
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3626
Mailing Address - Country:US
Mailing Address - Phone:818-999-2323
Mailing Address - Fax:
Practice Address - Street 1:20944 SHERMAN WAY STE 109
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3626
Practice Address - Country:US
Practice Address - Phone:818-999-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12331Medicare ID - Type Unspecified