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General NPI Number Information
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NPI Number | 1417054230
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Entity Type | Individual
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Provider Name | MISS CHITRA BHAKTA
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 245 S FETTERLY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-1605
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Country | US
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Telephone | 323-780-2216
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Fax | 323-264-3771
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Provider Business Mailing Address
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Address Line | 1525 SUPERIOR AVE STE 206
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3639
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Country | US
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Telephone | 949-642-3333
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Fax | 949-242-4020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A063631
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License Number State | CA
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