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NPI Code Detail

MEDICARE: BHAVANI INC

MEDICARE: BHAVANI INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2207Q00000XFamily Medicine PhysicianA54017CA

General Provider Information

NPI Number : 1093781189
Entity Type Code : Organization
Provider Name (Legal Business Name) : BHAVANI INC
Provider Business Mailing Address
First Line : 1035 PEACH STREET
Second Line : SUITE 301
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2700
Country : US
Telephone Number : 805-542-0900
Fax Number : 805-543-9580
Provider Business Practice Location Address
First Line : 1035 PEACH STREET
Second Line : SUITE 301
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2700
Country : US
Telephone Number : 805-542-0900
Fax Number : 805-543-9580
Authorized Official
Title or Position : CEO/CFO
Name : DONELLA JENKINS
Credential : M.D.
Telephone Number : 805-542-0900
Provider Enumeration Date : 02/27/2006
Last Update Date : 12/10/2013

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Directions to “BHAVANI INC ” Practice Location

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