Provider Demographics
NPI:1669521142
Name:RAJ BHATIA, M.D. INC
Entity type:Organization
Organization Name:RAJ BHATIA, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-485-2400
Mailing Address - Street 1:1910 OUTLET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-485-2455
Practice Address - Street 1:1910 OUTLET CENTER DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-485-2400
Practice Address - Fax:805-485-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61991207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63482Medicare UPIN
CAW16721DMedicare ID - Type Unspecified