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General NPI Number Information
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NPI Number | 1396972113
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Entity Type | Organization
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Legal Business Name | CHITRA BHAKTA M.D.A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 14591 NEWPORT AVE SUITE 208
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City | TUSTIN
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State | CA
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Zip | 92780-6001
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Country | US
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Telephone | 888-906-2462
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Fax |
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Provider Business Mailing Address
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Address Line | 14591 NEWPORT AVE SUITE 208
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City | TUSTIN
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State | CA
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Zip | 92780-6001
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Country | US
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Telephone | 888-906-2462
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHITRA ANJANI BHAKTA
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Credential | M.D.
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Telephone | 888-906-2462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A63631
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License Number State | CA
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