Healthcare Provider Details

I. General information

NPI: 1245218924
Provider Name (Legal Business Name): PUSHPA BISARYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 PANAMA LN STE G1001507
BAKERSFIELD CA
93307-5682
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax: 661-746-9197
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036065771
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC128327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: