=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841678539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MALWA DOCTORS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2015
-----------------------------------------------------
Last Update Date | 06/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6049 DOUGLAS BLVD STE 21
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-215-1757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 E ROSEVILLE PKWY # 140-217
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-3078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-215-1757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | HARKIRAT S SAGGU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-215-1495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 116970
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------