Healthcare Provider Details

I. General information

NPI: 1679747760
Provider Name (Legal Business Name): HARNEET SINGH BATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 HILL RD E SUITE D
LAKEPORT CA
95453-5101
US

IV. Provider business mailing address

3883 AIRWAY DR SUITE 300
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-6885
  • Fax: 707-263-6624
Mailing address:
  • Phone: 707-521-8809
  • Fax: 707-521-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA103419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: