Provider Demographics
NPI:1912129412
Name:JAGRAJ NIJJAR MD INC
Entity type:Organization
Organization Name:JAGRAJ NIJJAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-795-6693
Mailing Address - Street 1:P.O. BOX 468
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901
Mailing Address - Country:US
Mailing Address - Phone:530-674-9737
Mailing Address - Fax:530-674-9734
Practice Address - Street 1:945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4124
Practice Address - Country:US
Practice Address - Phone:281-795-6693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69180207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691800Medicaid
1689610990OtherNPI INDIVIDUAL
CA00A691803Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
CAZZZ02233ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
1689610990OtherNPI INDIVIDUAL