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General NPI Number Information
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NPI Number | 1477235406
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Entity Type | Organization
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Legal Business Name | MANDEEP BAGGA, MD, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 205 OCEAN AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2106
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Country | US
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Telephone | 989-714-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 S MOONEY BLVD # 1065
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City | VISALIA
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State | CA
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Zip | 93277-8067
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Country | US
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Telephone | 989-714-2110
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANDEEP SINGH BAGGA
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Credential | MD
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Telephone | 989-714-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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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 |
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License Number State |
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