Healthcare Provider Details

I. General information

NPI: 1811148356
Provider Name (Legal Business Name): BHAIRAVI KOTHARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 THE ALAMEDA
SAN JOSE CA
95126-1141
US

IV. Provider business mailing address

2115 THE ALAMEDA
SAN JOSE CA
95126-1141
US

V. Phone/Fax

Practice location:
  • Phone: 408-350-3280
  • Fax: 408-296-8918
Mailing address:
  • Phone: 408-350-3280
  • Fax: 408-296-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: