Healthcare Provider Details

I. General information

NPI: 1609698091
Provider Name (Legal Business Name): MANDEEP KAUR JAGGI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDEEP KAUR

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 408
LA MESA CA
91942-3076
US

IV. Provider business mailing address

12839 HIDEAWAY LN
SAN DIEGO CA
92131-4209
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-1174
  • Fax:
Mailing address:
  • Phone: 858-603-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: