Healthcare Provider Details

I. General information

NPI: 1174716765
Provider Name (Legal Business Name): SARBANI BHADURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 WOODBURY RD
GLENDALE CA
91206-2649
US

IV. Provider business mailing address

661 WOODBURY RD
GLENDALE CA
91206-2649
US

V. Phone/Fax

Practice location:
  • Phone: 415-613-6514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA53146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: