Healthcare Provider Details

I. General information

NPI: 1790965309
Provider Name (Legal Business Name): MANPREET BAINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 01/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E MAIN ST
TURLOCK CA
95380-3406
US

IV. Provider business mailing address

600 COFFEE RD
MODESTO CA
95355-4201
US

V. Phone/Fax

Practice location:
  • Phone: 209-632-3901
  • Fax:
Mailing address:
  • Phone: 209-521-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6599698-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: