Basic Information
Provider Information
NPI: 1003140856
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHAGVANJEE
FirstName: ANJNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1414 N.EDGEMONT
Address2: APT. C
City: LOS ANGELES
State: CA
PostalCode: 90027
CountryCode: US
TelephoneNumber: 2132915680
FaxNumber:  
Practice Location
Address1: 3367 GLENDALE BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900391825
CountryCode: US
TelephoneNumber: 2132915680
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/28/2009
LastUpdateDate: 09/28/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000XAC12857CAY Other Service ProvidersAcupuncturist 

No ID Information.


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