Provider Demographics
NPI:1144515099
Name:RAJIV ISHWARLAL BHAVSAR, M.D., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RAJIV ISHWARLAL BHAVSAR, M.D., A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:I
Authorized Official - Last Name:BHAVSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-441-0591
Mailing Address - Street 1:1321 N HARBOR BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4131
Mailing Address - Country:US
Mailing Address - Phone:714-441-0591
Mailing Address - Fax:714-441-0594
Practice Address - Street 1:1321 N HARBOR BLVD STE 302
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4131
Practice Address - Country:US
Practice Address - Phone:714-441-0591
Practice Address - Fax:714-441-0594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAJIV ISHWARLAL BHAVSAR, M.D., A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-17
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507170Medicaid
CA00C507170Medicaid