Provider Demographics
NPI:1194773168
Name:BHASKAR, BIRBAL SINGH (MD)
Entity type:Individual
Prefix:
First Name:BIRBAL
Middle Name:SINGH
Last Name:BHASKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BHASKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4304
Mailing Address - Country:US
Mailing Address - Phone:714-541-6622
Mailing Address - Fax:714-541-0531
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:714-541-6622
Practice Address - Fax:714-541-0531
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BF419ZOtherPTAN
CAGR0057460Medicaid
CAA25876Medicare UPIN
CAWA29781DMedicare ID - Type Unspecified