Healthcare Provider Details

I. General information

NPI: 1700062270
Provider Name (Legal Business Name): SHIVANI BHUTANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIVANI VERMA MD

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 TIMBERLAKE WAY SUITE 107
SACRAMENTO CA
95823-5412
US

IV. Provider business mailing address

3400 DATA DR QUALITY DEPARTMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-6000
  • Fax: 916-681-6188
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085893
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301085893
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC146231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: