Provider Demographics
NPI:1477756823
Name:BHALODIA, RAJESHKUMAR MANSUKHLAL (MD)
Entity Type:Individual
Prefix:
First Name:RAJESHKUMAR
Middle Name:MANSUKHLAL
Last Name:BHALODIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2020
Mailing Address - Country:US
Mailing Address - Phone:714-644-2418
Mailing Address - Fax:714-644-2435
Practice Address - Street 1:3460 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-2485
Practice Address - Fax:714-644-2435
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112565207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12121151OtherCAQH
CADG529YDOtherMEDICARE SO. CA