Healthcare Provider Details

I. General information

NPI: 1083602155
Provider Name (Legal Business Name): JAYARAM S. BHARADWAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR STE 203
ANAHEIM CA
92801-1824
US

IV. Provider business mailing address

1801 W ROMNEYA DR STE 203
ANAHEIM CA
92801-1824
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-1465
  • Fax: 714-999-1701
Mailing address:
  • Phone: 714-999-1465
  • Fax: 714-999-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2002001982
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: