Provider Demographics
NPI:1033426341
Name:JAISWAL, BHAVINI JASHVANT (MD)
Entity type:Individual
Prefix:
First Name:BHAVINI
Middle Name:JASHVANT
Last Name:JAISWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOAG DRIVE
Mailing Address - Street 2:CRITICAL CARE DEPARTMENT BOX 6100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-6100
Mailing Address - Country:US
Mailing Address - Phone:480-227-1318
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:CRITICAL CARE DEPARTMENT BOX 6100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:480-227-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100525207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease