Healthcare Provider Details

I. General information

NPI: 1568122976
Provider Name (Legal Business Name): CHRISTOPHER JAMES BAGTAS LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BERNAL RD
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

609 BLOM DR
SAN JOSE CA
95111-2704
US

V. Phone/Fax

Practice location:
  • Phone: 408-638-4744
  • Fax:
Mailing address:
  • Phone: 669-900-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number757946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: