Healthcare Provider Details

I. General information

NPI: 1366754541
Provider Name (Legal Business Name): RAJBEER SANGHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST # 201
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 209-645-4005
  • Fax: 209-645-6344
Mailing address:
  • Phone: 209-645-3771
  • Fax: 209-645-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberC179672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: