1245256064 NPI number — DR. BHAVESH ISHWARBHAI JANSARI M.D.

Table of content: DR. BHAVESH ISHWARBHAI JANSARI M.D. (NPI 1245256064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245256064 NPI number — DR. BHAVESH ISHWARBHAI JANSARI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANSARI
Provider First Name:
BHAVESH
Provider Middle Name:
ISHWARBHAI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245256064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 PARK PLAZA DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-9329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-977-4639
Provider Business Mailing Address Fax Number:
562-741-4479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 N ROSE DR
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-203-1767
Provider Business Practice Location Address Fax Number:
714-203-1782
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A94263 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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