Healthcare Provider Details

I. General information

NPI: 1427133545
Provider Name (Legal Business Name): GEETHA BHASKARA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

101 S 1ST ST #1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-1112
  • Fax: 661-949-5971
Mailing address:
  • Phone: 818-845-6206
  • Fax: 818-845-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA36890
License Number StateCA

VIII. Authorized Official

Name: DR. GEETHA BHASKARA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-943-1328