Healthcare Provider Details

I. General information

NPI: 1801905690
Provider Name (Legal Business Name): JOYDIP BHATTACHARYA DO MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 SOQUEL DRIVE SUITE B
SANTA CRUZ CA
95065-1700
US

IV. Provider business mailing address

1575 SOQUEL DR STE B
SANTA CRUZ CA
95065-1700
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-0599
  • Fax: 831-454-9157
Mailing address:
  • Phone: 831-454-0599
  • Fax: 831-454-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A8773
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYDIP BHATTACHARYA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 831-454-0599