Provider Demographics
NPI:1144558487
Name:BAGAN, PATRICK JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:BAGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:JOSEPH
Other - Last Name:MEDEIROS-BAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3178 HAMNER AVE # 4
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1936
Mailing Address - Country:US
Mailing Address - Phone:951-736-5646
Mailing Address - Fax:951-736-5694
Practice Address - Street 1:3178 HAMNER AVE # 4
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1936
Practice Address - Country:US
Practice Address - Phone:951-736-5646
Practice Address - Fax:951-736-5694
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic