Healthcare Provider Details

I. General information

NPI: 1487011052
Provider Name (Legal Business Name): BHAVNEET KAUR BHOGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23415 PLEASANT MEADOW RD
DIAMOND BAR CA
91765-3366
US

IV. Provider business mailing address

23415 PLEASANT MEADOW RD
DIAMOND BAR CA
91765-3366
US

V. Phone/Fax

Practice location:
  • Phone: 909-455-2321
  • Fax:
Mailing address:
  • Phone: 909-455-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT3544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: