Healthcare Provider Details

I. General information

NPI: 1871406132
Provider Name (Legal Business Name): NANDINI BHAKTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MAYLAND AVE
LA PUENTE CA
91746-1625
US

IV. Provider business mailing address

7825 LA CORONA WAY
BUENA PARK CA
90620-2303
US

V. Phone/Fax

Practice location:
  • Phone: 626-931-7742
  • Fax:
Mailing address:
  • Phone: 714-204-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: