Healthcare Provider Details

I. General information

NPI: 1740264191
Provider Name (Legal Business Name): BNHA HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 120
SANTA MONICA CA
90404-2094
US

IV. Provider business mailing address

1301 20TH ST STE 120
SANTA MONICA CA
90404-2094
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-6553
  • Fax: 310-828-5645
Mailing address:
  • Phone: 310-453-6553
  • Fax: 310-828-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. NILESH KOTADIYA
Title or Position: CFO/DIRECTOR
Credential:
Phone: 310-453-6553