Healthcare Provider Details

I. General information

NPI: 1164179552
Provider Name (Legal Business Name): BAKHT ROSHAN MD, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 EMILY WAY
MADERA CA
93637-5647
US

IV. Provider business mailing address

9594 N LARKSPUR AVE
FRESNO CA
93720-4620
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-5125
  • Fax:
Mailing address:
  • Phone: 617-319-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BAKHT ROSHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 617-319-7737