Provider Demographics
NPI:1992191829
Name:BHAKTA NUNEZ, BHAVISHA (DO)
Entity Type:Individual
Prefix:
First Name:BHAVISHA
Middle Name:
Last Name:BHAKTA NUNEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MILLER RD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9173
Mailing Address - Country:US
Mailing Address - Phone:817-303-0496
Mailing Address - Fax:
Practice Address - Street 1:2800 E BROAD ST STE 212
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6411
Practice Address - Country:US
Practice Address - Phone:682-242-8890
Practice Address - Fax:682-242-8896
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015019331207V00000X
TXS3357207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty