Provider Demographics
NPI:1225918105
Name:BAHRA, MICAH KATRINA (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:KATRINA
Last Name:BAHRA
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3610 CENTRAL AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5907
Mailing Address - Country:US
Mailing Address - Phone:442-327-9311
Mailing Address - Fax:442-327-9315
Practice Address - Street 1:3610 CENTRAL AVE STE 500
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5907
Practice Address - Country:US
Practice Address - Phone:442-327-9311
Practice Address - Fax:442-327-9315
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95036790363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health