Provider Demographics
NPI:1811543457
Name:VIJAYAKUMAR, BHARAVI BRAHMBHATT (NP)
Entity Type:Individual
Prefix:
First Name:BHARAVI
Middle Name:BRAHMBHATT
Last Name:VIJAYAKUMAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BHARAVI
Other - Middle Name:
Other - Last Name:BRAHMBHATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2410 SAMARITAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-5901
Mailing Address - Fax:
Practice Address - Street 1:2410 SAMARITAN DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3909
Practice Address - Country:US
Practice Address - Phone:408-371-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95011807OtherSTATE MEDICAL LICENSE