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General NPI Number Information
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NPI Number | 1902204449
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Entity Type | Organization
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Legal Business Name | SHYAM BHASKAR, M.D. INC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 1001 VAN DORSTEN AVE
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City | CORCORAN
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State | CA
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Zip | 93212-2321
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Country | US
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Telephone | 559-992-2337
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Fax |
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Provider Business Mailing Address
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Address Line | 231 W NOBLE AVE
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City | VISALIA
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State | CA
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Zip | 93277-2631
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Country | US
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Telephone | 559-635-7100
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Fax | 559-635-7106
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. MARTHA SEPEDA
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Credential |
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Telephone | 559-635-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | CA
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