Provider Demographics
NPI:1790146819
Name:JAGPAL, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JAGPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3747 GRESHAM LANE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835
Mailing Address - Country:US
Mailing Address - Phone:209-505-9637
Mailing Address - Fax:
Practice Address - Street 1:3747 GRESHAM LANE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835
Practice Address - Country:US
Practice Address - Phone:209-505-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist