Provider Demographics
NPI:1164960670
Name:CHITRA BHAKTA MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHITRA BHAKTA MD, A PROFESSIONAL CORPORATION
Other - Org Name:ORANGE COUNTY INTEGRATIVE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:ANJANI
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-642-3333
Mailing Address - Street 1:1525 SUPERIOR AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3639
Mailing Address - Country:US
Mailing Address - Phone:949-642-3333
Mailing Address - Fax:949-242-4020
Practice Address - Street 1:1525 SUPERIOR AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3639
Practice Address - Country:US
Practice Address - Phone:949-642-3333
Practice Address - Fax:949-242-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty