Provider Demographics
NPI:1154679447
Name:SHYAM BHASKAR, M.D. INC
Entity Type:Organization
Organization Name:SHYAM BHASKAR, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-635-7100
Mailing Address - Street 1:231 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2631
Mailing Address - Country:US
Mailing Address - Phone:559-635-7100
Mailing Address - Fax:559-635-7106
Practice Address - Street 1:1425 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-1726
Practice Address - Country:US
Practice Address - Phone:661-778-0920
Practice Address - Fax:661-778-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74119261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH89399Medicare UPIN