Provider Demographics
NPI:1609611896
Name:PADDA, GAGANDEEP SINGH
Entity type:Individual
Prefix:MR
First Name:GAGANDEEP
Middle Name:SINGH
Last Name:PADDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 W FOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4689
Mailing Address - Country:US
Mailing Address - Phone:559-394-5186
Mailing Address - Fax:
Practice Address - Street 1:4066 W FOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4689
Practice Address - Country:US
Practice Address - Phone:559-394-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732218164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse