Healthcare Provider Details

I. General information

NPI: 1700225703
Provider Name (Legal Business Name): MAHEEP SINGH SANGHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR STE 200
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

23 UPPER RAGSDALE DR STE 200
MONTEREY CA
93940-7849
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.063412
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15301
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: