Healthcare Provider Details

I. General information

NPI: 1902204449
Provider Name (Legal Business Name): SHYAM BHASKAR, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 VAN DORSTEN AVE
CORCORAN CA
93212-2321
US

IV. Provider business mailing address

231 W NOBLE AVE
VISALIA CA
93277-2631
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-2337
  • Fax:
Mailing address:
  • Phone: 559-635-7100
  • Fax: 559-635-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. MARTHA SEPEDA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 559-635-7100