Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 4301076239 | MI |
N | 207VX0000X | Obstetrician | A109934 | CA |
NPI | 1053529404 |
---|---|
Provider Name | Dr. Charnpal S Mangat |
First Address | Lodi, CA 95241-1090 |
Second Address | Stockton, CA 95204-6117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 25/11/2009 |