Provider Demographics
NPI:1366593519
Name:BHUTANI, SEEMA G (HT)
Entity type:Individual
Prefix:
First Name:SEEMA
Middle Name:G
Last Name:BHUTANI
Suffix:
Gender:F
Credentials:HT
Other - Prefix:
Other - First Name:MOHS-TEK
Other - Middle Name:
Other - Last Name:INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1160
Mailing Address - Country:US
Mailing Address - Phone:714-235-9460
Mailing Address - Fax:949-559-6647
Practice Address - Street 1:14785 JEFFREY RD
Practice Address - Street 2:SUITE #201
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0408
Practice Address - Country:US
Practice Address - Phone:949-551-6647
Practice Address - Fax:949-559-6647
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99039304246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX05D000012Medicare PIN