Healthcare Provider Details

I. General information

NPI: 1073848123
Provider Name (Legal Business Name): JONI ARTI BHUTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24515 KANSAS ST
NEWHALL CA
91321-1719
US

IV. Provider business mailing address

24515 KANSAS ST
NEWHALL CA
91321-1719
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-4971
  • Fax:
Mailing address:
  • Phone: 661-253-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA107601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: