MEDICARE: PRAGNA BHAKTA M.S., CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	12205	CA

General Provider Information

NPI Number	:	1740599836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAGNA BHAKTA M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	3954 ALLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4114
Country	:	US
Telephone Number	:	213-268-2053
Fax Number	:

Provider Business Practice Location Address
First Line	:	3954 ALLA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4114
Country	:	US
Telephone Number	:	213-268-2053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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Directions to “ PRAGNA BHAKTA M.S., CCC-SLP” Practice Location

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