Healthcare Provider Details

I. General information

NPI: 1619008661
Provider Name (Legal Business Name): MOHAMMAD JAVAID BHATTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD JAVAID MD

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BLAKELY LN
MODESTO CA
95356-8984
US

IV. Provider business mailing address

1325 BLAKELY LN
MODESTO CA
95356-8984
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-1644
  • Fax: 209-557-1685
Mailing address:
  • Phone: 209-557-1644
  • Fax: 209-557-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC50848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: