Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A102581 | CA |
N | 2084N0402X | Child Neurologist | 35.120197 | OH |
Y | 2084N0402X | Child Neurologist | 57948 | AZ |
NPI | 1346434610 |
---|---|
Provider Name | Mrs. Poonam Bhatia |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
518705 | (05) | AZ |