Provider Demographics
NPI:1518937754
Name:BHOLA, RAKESH K (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:K
Last Name:BHOLA
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 1:1801 W ROMNEYA DR
Mailing Address - Street 2:#504
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-776-3424
Mailing Address - Fax:714-956-0341
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:#504
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-776-3424
Practice Address - Fax:714-956-0341
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA039683207RP1001X
CAA39683207QG0300X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0021080Medicaid
A28942Medicare UPIN
CAW10873Medicare ID - Type Unspecified