Basic Information
Provider Information
NPI: 1083168439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHARDWAJ
FirstName: KARISHMA
MiddleName: AMIN
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1450 TREAT BLVD # 300
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945972168
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber:  
Practice Location
Address1: 2621 SHADELANDS DR
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945982512
CountryCode: US
TelephoneNumber: 9259470417
FaxNumber: 9253787968
Other Information
ProviderEnumerationDate: 08/14/2016
LastUpdateDate: 03/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X95004436CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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