Provider Demographics
NPI:1003412339
Name:BHATIA, SHARUTI DOLLY
Entity Type:Individual
Prefix:
First Name:SHARUTI
Middle Name:DOLLY
Last Name:BHATIA
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 1:323 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4432
Mailing Address - Country:US
Mailing Address - Phone:415-265-0500
Mailing Address - Fax:
Practice Address - Street 1:1537 S BOSTON LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-6471
Practice Address - Country:US
Practice Address - Phone:141-526-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily