Healthcare Provider Details

I. General information

NPI: 1245436328
Provider Name (Legal Business Name): BHUBANESH KUMAR BHATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 HOSPITAL RD SUITE H
ATWATER CA
95301-5173
US

IV. Provider business mailing address

3605 HOSPITAL RD SUITE H
ATWATER CA
95301-5173
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-2000
  • Fax:
Mailing address:
  • Phone: 209-381-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.089988
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: