Healthcare Provider Details

I. General information

NPI: 1295761229
Provider Name (Legal Business Name): RAJESH K. BHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3849
US

IV. Provider business mailing address

PO BOX 1628
ORANGE CA
92856-0628
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-9111
  • Fax: 714-744-8695
Mailing address:
  • Phone: 714-560-1580
  • Fax: 714-560-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA88819
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA88819
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA88819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: