Healthcare Provider Details

I. General information

NPI: 1518937754
Provider Name (Legal Business Name): RAKESH K BHOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR #504
ANAHEIM CA
92801
US

IV. Provider business mailing address

1801 W ROMNEYA DR #504
ANAHEIM CA
92801
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-3424
  • Fax: 714-956-0341
Mailing address:
  • Phone: 714-776-3424
  • Fax: 714-956-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA39683
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA39683
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA39683
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA039683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: