Healthcare Provider Details

I. General information

NPI: 1932661931
Provider Name (Legal Business Name): PALLAVI BHAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 CARMEL MOUNTAIN RD STE 1104
SAN DIEGO CA
92128-4610
US

IV. Provider business mailing address

11865 CARMEL MOUNTAIN RD STE 1104
SAN DIEGO CA
92128-4610
US

V. Phone/Fax

Practice location:
  • Phone: 858-997-2583
  • Fax:
Mailing address:
  • Phone: 858-997-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA177480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: