Healthcare Provider Details

I. General information

NPI: 1649369109
Provider Name (Legal Business Name): THE PADDY JIM BAGGOT MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WILSHIRE BLVD SUITE #219
LOS ANGELES CA
90010-1120
US

IV. Provider business mailing address

3020 WILSHIRE BLVD SUITE 219
LOS ANGELES CA
90010-1120
US

V. Phone/Fax

Practice location:
  • Phone: 213-386-2606
  • Fax: 213-386-2603
Mailing address:
  • Phone: 213-386-2606
  • Fax: 213-386-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK JAMES BAGGOT
Title or Position: OWNER
Credential: MD
Phone: 818-448-0213