Healthcare Provider Details

I. General information

NPI: 1386453595
Provider Name (Legal Business Name): ANOOP BHAMBRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 W 130TH ST
CLEVELAND OH
44135-3758
US

IV. Provider business mailing address

4675 W 130TH ST
CLEVELAND OH
44135-3758
US

V. Phone/Fax

Practice location:
  • Phone: 216-401-1049
  • Fax:
Mailing address:
  • Phone: 216-401-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: