Provider Demographics
NPI:1659640316
Name:BAKANI, ROBERTO C (LVN)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:C
Last Name:BAKANI
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 VALENTINO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4254
Mailing Address - Country:US
Mailing Address - Phone:714-552-9918
Mailing Address - Fax:
Practice Address - Street 1:2045 VALENTINO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4254
Practice Address - Country:US
Practice Address - Phone:714-552-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250116164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse