Provider Demographics
NPI:1790895050
Name:BHUTTO, ZAHIDA R (MD)
Entity Type:Individual
Prefix:
First Name:ZAHIDA
Middle Name:R
Last Name:BHUTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N THIRD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1917
Mailing Address - Country:US
Mailing Address - Phone:626-915-4400
Mailing Address - Fax:626-915-4411
Practice Address - Street 1:315 N THIRD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1917
Practice Address - Country:US
Practice Address - Phone:626-915-4400
Practice Address - Fax:626-915-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45139207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451391Medicaid
CA00A451390OtherBLUE CROSS BLUE SHIELD
CAA45139Medicare ID - Type Unspecified
D16827Medicare UPIN
CA00A451391Medicaid