Provider Demographics
NPI:1487011052
Name:BHOGAL, BHAVNEET KAUR
Entity type:Individual
Prefix:
First Name:BHAVNEET
Middle Name:KAUR
Last Name:BHOGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23415 PLEASANT MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3366
Mailing Address - Country:US
Mailing Address - Phone:909-455-2321
Mailing Address - Fax:
Practice Address - Street 1:23415 PLEASANT MEADOW RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3366
Practice Address - Country:US
Practice Address - Phone:909-455-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3544314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility