Basic Information
| Provider Information | |||||||||
| NPI: | 1912033838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATT | ||||||||
| FirstName: | DHVANI | ||||||||
| MiddleName: | DIPAK | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21967 WHITE OAK RD | ||||||||
| Address2: | |||||||||
| City: | WALNUT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917890924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095986395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E.DUARTE ROAD | ||||||||
| Address2: | |||||||||
| City: | DUARTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262564673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 718177 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.