Healthcare Provider Details

I. General information

NPI: 1457486102
Provider Name (Legal Business Name): JITENDRA R BHATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34561 CAMINO CAPISTRANO
CAPISTRANO BEACH CA
92624-1231
US

IV. Provider business mailing address

34561 CAMINO CAPISTRANO
CAPISTRANO BEACH CA
92624-1231
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-1821
  • Fax:
Mailing address:
  • Phone: 949-496-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCFE26213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: