Provider Demographics
NPI:1689610990
Name:NIJJAR, JAGRAJ (MD)
Entity Type:Individual
Prefix:
First Name:JAGRAJ
Middle Name:
Last Name:NIJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-0468
Mailing Address - Country:US
Mailing Address - Phone:530-674-9737
Mailing Address - Fax:306-671-1089
Practice Address - Street 1:1531 PLUMAS CT
Practice Address - Street 2:STE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2960
Practice Address - Country:US
Practice Address - Phone:530-674-9737
Practice Address - Fax:530-674-9734
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69180207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691800Medicaid
CA610964000OtherWORK COMP PROVIDER ID
CAP00254932OtherMEDICARE RAILROAD ID
1912129412OtherNPI GROUP
CAH03351Medicare UPIN
00A691800Medicare PIN
1912129412OtherNPI GROUP