Provider Demographics
NPI:1780398743
Name:BHAKTA, HEEREN PRAVINKUMAR
Entity type:Individual
Prefix:
First Name:HEEREN
Middle Name:PRAVINKUMAR
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16588 PATHFINDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-9498
Mailing Address - Country:US
Mailing Address - Phone:714-357-6760
Mailing Address - Fax:
Practice Address - Street 1:230 CALIFORNIA ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-4378
Practice Address - Country:US
Practice Address - Phone:415-989-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist