Provider Demographics
NPI:1245242783
Name:BAJO, PHILIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:B
Last Name:BAJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:3
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-482-0112
Mailing Address - Fax:619-482-2194
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:3
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-482-0112
Practice Address - Fax:619-482-2194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC040750207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C407500Medicaid
CA00C407500Medicaid
CAC35681Medicare UPIN