Healthcare Provider Details

I. General information

NPI: 1144319609
Provider Name (Legal Business Name): PATRICK JAMES BAGGOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PADDY JIM BAGGOT MD

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/29/2015
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 NumberG84916
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG84916
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG84916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: