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General NPI Number Information
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NPI Number | 1649855727
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Entity Type | Individual
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Provider Name | BHARATHI RASAGOLLA FNP
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Gender | Female
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 4902 IRVINE CENTER DR STE 105
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City | IRVINE
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State | CA
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Zip | 92604-3334
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Country | US
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Telephone | 949-651-9671
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Fax |
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Provider Business Mailing Address
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Address Line | 132 LOST HLS
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City | IRVINE
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State | CA
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Zip | 92618-0823
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Country | US
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Telephone | 714-350-3350
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95016061
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License Number State | CA
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