Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP95001362 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95001362 | CA |
NPI | 1073990859 |
---|---|
Provider Name | Manju Bhalla |
First Address | Bakersfield, CA 93390-1345 |
Second Address | Bakersfield, CA 93309-0418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2015 |
Last Update Date | 21/01/2019 |