Healthcare Provider Details

I. General information

NPI: 1396061461
Provider Name (Legal Business Name): RUJUTA BHATT WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUJUTA RAJIV BHATT M.D

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number120125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: