MEDICARE: NISHAN MANGAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A189180	CA

General Provider Information

NPI Number	:	1275160137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHAN MANGAT

Provider Business Mailing Address
First Line	:	4404 CIMARRON RIDGE DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-5545
Country	:	US
Telephone Number	:	661-378-2767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 CIMARRON RIDGE DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-5545
Country	:	US
Telephone Number	:	661-378-2767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	09/06/2023

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Directions to “ NISHAN MANGAT ” Practice Location

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