Provider Demographics
NPI:1528214046
Name:J S BISLA LLC
Entity Type:Organization
Organization Name:J S BISLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BISLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-876-1634
Mailing Address - Street 1:8232 W CACTUS RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5217
Mailing Address - Country:US
Mailing Address - Phone:623-876-1634
Mailing Address - Fax:623-776-3436
Practice Address - Street 1:8232 W CACTUS RD
Practice Address - Street 2:SUITE 124
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5217
Practice Address - Country:US
Practice Address - Phone:623-876-1634
Practice Address - Fax:623-776-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty