Healthcare Provider Details

I. General information

NPI: 1750419230
Provider Name (Legal Business Name): PRITI BHARDWAJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/18/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 216
SANTA ANA CA
92705-6506
US

IV. Provider business mailing address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 949-609-0374
Mailing address:
  • Phone: 714-545-5550
  • Fax: 714-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA94479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: