Healthcare Provider Details

I. General information

NPI: 1952402141
Provider Name (Legal Business Name): BANU BRAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 COFFEE RD SUITE 2A
MODESTO CA
95355-1582
US

IV. Provider business mailing address

3425 COFFEE RD SUITE 2A
MODESTO CA
95355-1582
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-9402
  • Fax:
Mailing address:
  • Phone: 209-521-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA94879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: