Provider Demographics
NPI:1588287676
Name:BACHU, MEGHANA
Entity type:Individual
Prefix:
First Name:MEGHANA
Middle Name:
Last Name:BACHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3732
Mailing Address - Country:US
Mailing Address - Phone:510-248-1680
Mailing Address - Fax:510-797-0236
Practice Address - Street 1:6236 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3732
Practice Address - Country:US
Practice Address - Phone:510-248-1680
Practice Address - Fax:510-797-0236
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61086363363LF0000X
390200000X
CA95019687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program