Provider Demographics
NPI:1619790722
Name:BAKSHI, SANJAY K (BSC)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:K
Last Name:BAKSHI
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1505
Mailing Address - Country:US
Mailing Address - Phone:510-672-3648
Mailing Address - Fax:
Practice Address - Street 1:133 FALCON WAY
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1505
Practice Address - Country:US
Practice Address - Phone:510-672-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7447070172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver