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General NPI Number Information
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NPI Number | 1487011052
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Entity Type | Individual
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Provider Name | BHAVNEET KAUR BHOGAL
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Gender | Female
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 23415 PLEASANT MEADOW RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3366
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Country | US
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Telephone | 909-455-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 23415 PLEASANT MEADOW RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3366
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Country | US
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Telephone | 909-455-2321
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Fax |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT3544
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License Number State | CA
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