Healthcare Provider Details

I. General information

NPI: 1285651166
Provider Name (Legal Business Name): JUMA A BHARADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22617 HAWTHORNE BLVD
TORRANCE CA
90505-2510
US

IV. Provider business mailing address

24325 CRENSHAW BLVD
TORRANCE CA
90505-5349
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-4700
  • Fax: 310-370-4744
Mailing address:
  • Phone: 310-370-4700
  • Fax: 310-377-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA56515
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA56515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: