Healthcare Provider Details

I. General information

NPI: 1699017475
Provider Name (Legal Business Name): BIPIN JOT SINGH BAGGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 12/20/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2310
US

IV. Provider business mailing address

1011 RIVERSIDE AVE
ROSEVILLE CA
95678-5134
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6400
  • Fax: 505-462-6506
Mailing address:
  • Phone: 916-784-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0787
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA171338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: