MEDICARE: BHAGYA NAKKA MD

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	174400000X	Specialist	A96365	CA
2	207V00000X	Obstetrics & Gynecology Physician	A96365	CA

General Provider Information

NPI Number	:	1699780494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAGYA NAKKA MD

Provider Business Mailing Address
First Line	:	420 W ACACIA ST
Second Line	:	SUITE 22
City	:	STOCKTON
State	:	CA
Zip	:	95203-2441
Country	:	US
Telephone Number	:	209-242-2690
Fax Number	:	209-242-2694

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 202
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-242-2690
Fax Number	:	209-242-2694

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	02/21/2023

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