Provider Demographics
NPI:1265691349
Name:DASWANI, BHARTI NEIL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BHARTI
Middle Name:NEIL
Last Name:DASWANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BHARTI
Other - Middle Name:N
Other - Last Name:DASWANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:875 BLAKE WILBUR DR., RM 2233
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-724-5856
Mailing Address - Fax:
Practice Address - Street 1:875 BLAKE WILBUR DR., RM 2233
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-724-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17145363AS0400X
CA17145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical