Healthcare Provider Details

I. General information

NPI: 1396150736
Provider Name (Legal Business Name): RUSHA BHANDARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUSHA SHAH M.D.

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-4673
  • Fax:
Mailing address:
  • Phone: 626-775-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014016674
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA148298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: