Provider Demographics
NPI:1174061410
Name:BAGGAO, MARIA CONCEPCION MEDINA (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:MARIA CONCEPCION
Middle Name:MEDINA
Last Name:BAGGAO
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:MARIA CONCEPCION
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 N. LA CUMBRE RD
Mailing Address - Street 2:STE M
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110
Mailing Address - Country:US
Mailing Address - Phone:805-324-4399
Mailing Address - Fax:805-770-2475
Practice Address - Street 1:200 N LA CUMBRE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-2587
Practice Address - Country:US
Practice Address - Phone:805-687-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005073363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005073OtherNURSE PRACTIONER LICENSE