Healthcare Provider Details

I. General information

NPI: 1003412339
Provider Name (Legal Business Name): SHARUTI DOLLY BHATIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E KATELLA AVE
ANAHEIM CA
92805-6614
US

IV. Provider business mailing address

801 E KATELLA AVE
ANAHEIM CA
92805-6614
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-6373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: