Provider Demographics
NPI:1609698091
Name:JAGGI, MANDEEP KAUR (NP)
Entity type:Individual
Prefix:MRS
First Name:MANDEEP
Middle Name:KAUR
Last Name:JAGGI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MANDEEP
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12839 HIDEAWAY LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4209
Mailing Address - Country:US
Mailing Address - Phone:858-603-4081
Mailing Address - Fax:
Practice Address - Street 1:8851 CENTER DR STE 408
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3076
Practice Address - Country:US
Practice Address - Phone:619-583-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily