1477235406 NPI number — MANDEEP BAGGA, MD, A MEDICAL CORPORATION

Table of content: (NPI 1477235406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477235406 NPI number — MANDEEP BAGGA, MD, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANDEEP BAGGA, MD, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477235406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3643 S MOONEY BLVD # 1065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93277-8067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-714-2110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 OCEAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92651-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-714-2110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BAGGA
Authorized Official First Name:
MANDEEP
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-714-2110

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com