MEDICARE: IMELDA CASTRO BAGIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NPF95027827	CA

General Provider Information

NPI Number	:	1275331779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMELDA CASTRO BAGIS

Provider Business Mailing Address
First Line	:	1433 LITTLE ORCHARD ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-3502
Country	:	US
Telephone Number	:	408-219-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 LITTLE ORCHARD ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-3502
Country	:	US
Telephone Number	:	408-219-5202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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Directions to “ IMELDA CASTRO BAGIS ” Practice Location

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