Healthcare Provider Details

I. General information

NPI: 1679337646
Provider Name (Legal Business Name): PAYAL SAMIR BHAVSAR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17450 MAIN ST STE D
HESPERIA CA
92345-6262
US

IV. Provider business mailing address

9913 LIGHTNER WAY
BAKERSFIELD CA
93311-3042
US

V. Phone/Fax

Practice location:
  • Phone: 949-783-3600
  • Fax:
Mailing address:
  • Phone: 661-593-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95192484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: