Provider Demographics
NPI:1386989085
Name:BHANGDA, MARIUM (NP)
Entity type:Individual
Prefix:
First Name:MARIUM
Middle Name:
Last Name:BHANGDA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 VENETO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5968
Mailing Address - Country:US
Mailing Address - Phone:407-924-9812
Mailing Address - Fax:
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-517-2100
Practice Address - Fax:714-560-7678
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA781264163W00000X
CA22726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse