Healthcare Provider Details

I. General information

NPI: 1063552735
Provider Name (Legal Business Name): SUDHA U BHAGIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19520 NORDHOFF ST SUITE 5
NORTHRIDGE CA
91324-2428
US

IV. Provider business mailing address

5555 GARDEN GROVE BLVD STE 200
WESTMINSTER CA
92683
US

V. Phone/Fax

Practice location:
  • Phone: 818-734-9124
  • Fax:
Mailing address:
  • Phone: 714-898-5732
  • Fax: 714-901-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7101
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU2251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: