Healthcare Provider Details

I. General information

NPI: 1871715821
Provider Name (Legal Business Name): MEERA BHAGAUTI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEERA BHAGAUTI PITTS M.A.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11041 VALLEY BLVD
EL MONTE CA
91731-2516
US

IV. Provider business mailing address

3839 GOLDWYN TER
CULVER CITY CA
90232-3103
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-4177
  • Fax: 626-442-4498
Mailing address:
  • Phone: 626-442-4177
  • Fax: 626-442-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: