Healthcare Provider Details

I. General information

NPI: 1871818385
Provider Name (Legal Business Name): SAMIT BHATHEJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE
UPLAND CA
91786-4916
US

IV. Provider business mailing address

685 N 13TH AVE
UPLAND CA
91786-4916
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8383
  • Fax: 909-920-3054
Mailing address:
  • Phone: 909-981-8383
  • Fax: 909-920-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC188373
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberC188373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: