Provider Demographics
NPI:1093781189
Name:BHAVANI INC
Entity Type:Organization
Organization Name:BHAVANI INC
Other - Org Name:HEALTHWORKS OF THE CENTRAL COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-542-0900
Mailing Address - Street 1:1035 PEACH STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2700
Mailing Address - Country:US
Mailing Address - Phone:805-542-0900
Mailing Address - Fax:805-543-9580
Practice Address - Street 1:1035 PEACH STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-542-0900
Practice Address - Fax:805-543-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAA54017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18404Medicare PIN
CAG77466Medicare UPIN