Provider Demographics
NPI:1396851580
Name:BHUTWALA, ASHVIN V (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHVIN
Middle Name:V
Last Name:BHUTWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHVIN
Other - Middle Name:V
Other - Last Name:BHUTWALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17199 YUMA ST
Mailing Address - Street 2:STE 1
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5886
Mailing Address - Country:US
Mailing Address - Phone:760-244-1155
Mailing Address - Fax:760-244-1115
Practice Address - Street 1:17199 YUMA ST
Practice Address - Street 2:STE 1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5886
Practice Address - Country:US
Practice Address - Phone:760-244-1155
Practice Address - Fax:760-244-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514810Medicaid
CA00A514810Medicaid
00A514810Medicare ID - Type Unspecified