Healthcare Provider Details

I. General information

NPI: 1881129013
Provider Name (Legal Business Name): ALESSIA BHARGAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 4TH ST
SAN RAFAEL CA
94901-3213
US

IV. Provider business mailing address

PO BOX 91
DURHAM NC
27702-0091
US

V. Phone/Fax

Practice location:
  • Phone: 415-532-1127
  • Fax:
Mailing address:
  • Phone: 713-517-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA184215
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU2791
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019-00983
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11647100
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA184215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: