Healthcare Provider Details

I. General information

NPI: 1598709719
Provider Name (Legal Business Name): MONICA BHARGAVA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0S013033
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP0006
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: