Provider Demographics
NPI:1386028629
Name:BAJWA ENTERPRISES
Entity Type:Organization
Organization Name:BAJWA ENTERPRISES
Other - Org Name:PURIFY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-278-1450
Mailing Address - Street 1:30200 AGOURA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5427
Mailing Address - Country:US
Mailing Address - Phone:805-278-1450
Mailing Address - Fax:
Practice Address - Street 1:30200 AGOURA RD STE 150
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5427
Practice Address - Country:US
Practice Address - Phone:805-278-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty