Healthcare Provider Details

I. General information

NPI: 1851449706
Provider Name (Legal Business Name): MANISHA K. BHATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S IDAHO ST SUITE 190
LA HABRA CA
90631-6047
US

IV. Provider business mailing address

501 S IDAHO ST SUITE 260
LA HABRA CA
90631-6047
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-0400
  • Fax: 562-501-1198
Mailing address:
  • Phone: 562-501-1720
  • Fax: 562-501-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA69238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: