Healthcare Provider Details

I. General information

NPI: 1467462143
Provider Name (Legal Business Name): ZANDRA TUTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZANDRA WHITAKER

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19351 LURIN AVE
RIVERSIDE CA
92508-9608
US

IV. Provider business mailing address

1835 E HALLANDALE BLVD 127
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 954-937-2944
  • Fax:
Mailing address:
  • Phone: 305-416-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0062990
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA54432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: