Provider Demographics
NPI:1073990859
Name:BHALLA, MANJU
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:BHALLA
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:PO BOX 21345
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1345
Mailing Address - Country:US
Mailing Address - Phone:661-316-6000
Mailing Address - Fax:
Practice Address - Street 1:4900 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0418
Practice Address - Country:US
Practice Address - Phone:661-395-0900
Practice Address - Fax:661-395-0700
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001362363LF0000X
CA95001362363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily