Provider Demographics
NPI:1740444777
Name:BHANSALI, RAKESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAKESH KUMAR
Middle Name:
Last Name:BHANSALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2302
Mailing Address - Country:US
Mailing Address - Phone:760-482-4004
Mailing Address - Fax:760-352-0798
Practice Address - Street 1:202 N 8TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2302
Practice Address - Country:US
Practice Address - Phone:760-482-4004
Practice Address - Fax:760-352-0798
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI535572084P0800X
CAA1193522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program