Provider Demographics
NPI:1588007678
Name:HARBUTT, SUSANA INES SMITH (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:INES SMITH
Last Name:HARBUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-1844
Mailing Address - Fax:510-506-7729
Practice Address - Street 1:20101 LAKE CHABOT RD FL 4
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-204-1844
Practice Address - Fax:510-506-7729
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136741207R00000X, 207RE0101X
GA92819207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA136741OtherSTATE MEDICAL LICENSE
CAA136741OtherSTATE MEDICAL LICENSE