Provider Demographics
NPI:1013002625
Name:BHALLA, SARBPAUL S (MD)
Entity Type:Individual
Prefix:DR
First Name:SARBPAUL
Middle Name:S
Last Name:BHALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4012
Mailing Address - Country:US
Mailing Address - Phone:562-427-8119
Mailing Address - Fax:562-427-7132
Practice Address - Street 1:3610 LONG BEACH BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4012
Practice Address - Country:US
Practice Address - Phone:562-427-8119
Practice Address - Fax:562-427-7132
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36251207X00000X, 207XS0117X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362512Medicaid
CAC08384Medicare UPIN
CAW16391Medicare ID - Type Unspecified
CA00A362512Medicaid