Provider Demographics
NPI:1184707242
Name:VINOD C BHAN
Entity type:Organization
Organization Name:VINOD C BHAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:209-956-7725
Mailing Address - Street 1:1144 NORMAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5925
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-823-3376
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-956-7725
Practice Address - Fax:209-948-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA41367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03666ZOtherGROUP PTAN
CAZZZ03666ZOtherGROUP PTAN