Provider Demographics
NPI:1922427350
Name:BHATT, PALAK
Entity Type:Individual
Prefix:
First Name:PALAK
Middle Name:
Last Name:BHATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SOUTHWEST PKWY
Mailing Address - Street 2:APT 1408
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4874
Mailing Address - Country:US
Mailing Address - Phone:909-556-6446
Mailing Address - Fax:
Practice Address - Street 1:1101 SOUTHWEST PKWY
Practice Address - Street 2:APT 1408
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4874
Practice Address - Country:US
Practice Address - Phone:909-556-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1238150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility