Provider Demographics
NPI:1477235406
Name:MANDEEP BAGGA, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MANDEEP BAGGA, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-714-2110
Mailing Address - Street 1:3643 S MOONEY BLVD # 1065
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8067
Mailing Address - Country:US
Mailing Address - Phone:989-714-2110
Mailing Address - Fax:
Practice Address - Street 1:205 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2106
Practice Address - Country:US
Practice Address - Phone:989-714-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty