Provider Demographics
NPI:1477550648
Name:BHAVSAR, RAJIV I (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:I
Last Name:BHAVSAR
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 1:1321 N HARBOR BLVD
Mailing Address - Street 2:SUITE # 302
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4124
Mailing Address - Country:US
Mailing Address - Phone:714-441-0591
Mailing Address - Fax:714-441-0594
Practice Address - Street 1:1321 N HARBOR BLVD
Practice Address - Street 2:SUITE # 302
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4124
Practice Address - Country:US
Practice Address - Phone:714-441-0591
Practice Address - Fax:714-441-0594
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 50717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C507170Medicaid
CA00C507170Medicaid