Healthcare Provider Details

I. General information

NPI: 1730756842
Provider Name (Legal Business Name): MANDEEP BAINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 N THESTA ST
FRESNO CA
93710-5266
US

IV. Provider business mailing address

3308 OLIVE ST
SELMA CA
93662-4172
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: