Provider Demographics
NPI:1619008661
Name:BHATTI, MOHAMMAD JAVAID (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:JAVAID
Last Name:BHATTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:JAVAID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1325 BLAKELY LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8984
Mailing Address - Country:US
Mailing Address - Phone:209-557-1644
Mailing Address - Fax:209-557-1685
Practice Address - Street 1:1325 BLAKELY LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8984
Practice Address - Country:US
Practice Address - Phone:209-557-1644
Practice Address - Fax:209-557-1685
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics