Healthcare Provider Details

I. General information

NPI: 1578606505
Provider Name (Legal Business Name): SUCHETA BHATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 W TOWN AND COUNTRY RD
ORANGE CA
92868-4716
US

IV. Provider business mailing address

GENZYME GENETICS 1054 TOWN AND COUNTRY ROAD
ORANGE CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-9240
  • Fax: 714-245-9259
Mailing address:
  • Phone: 714-245-9240
  • Fax: 714-245-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberA43205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD00022214
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: