MEDICARE: DR. BHAVESH ISHWARBHAI JANSARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A94263	CA

General Provider Information

NPI Number	:	1245256064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAVESH ISHWARBHAI JANSARI M.D.

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

Provider Business Practice Location Address
First Line	:	1325 N ROSE DR
Second Line	:	#102
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3840
Country	:	US
Telephone Number	:	714-203-1767
Fax Number	:	714-203-1782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/09/2019

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