Healthcare Provider Details

I. General information

NPI: 1922393388
Provider Name (Legal Business Name): ABESH KUMAR BHATTACHARJEE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR ROOM # 9116A
LA JOLLA CA
92093-9116
US

IV. Provider business mailing address

9500 GILMAN DR ROOM # 9116A
LA JOLLA CA
92093-9116
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax: 858-822-0231
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA122409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: