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General NPI Number Information
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NPI Number | 1043414204
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Entity Type | Individual
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Provider Name | NITIN D BAGUL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 201 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002
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Country | US
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Telephone | 530-768-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 SUNFLOWER DR
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City | REDDING
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State | CA
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Zip | 96001-0164
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Country | US
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Telephone | 608-819-8258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 54740-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A115458
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License Number State | CA
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