Provider Demographics
NPI:1891518031
Name:BHATTARAI, SUSMITA BAGALE
Entity type:Individual
Prefix:
First Name:SUSMITA
Middle Name:BAGALE
Last Name:BHATTARAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSMITA
Other - Middle Name:
Other - Last Name:BAGALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20675 MARIA CT
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4462
Mailing Address - Country:US
Mailing Address - Phone:510-589-0220
Mailing Address - Fax:
Practice Address - Street 1:20675 MARIA CT
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4462
Practice Address - Country:US
Practice Address - Phone:510-589-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95396915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse