Healthcare Provider Details

I. General information

NPI: 1659321610
Provider Name (Legal Business Name): NATALYA SHTUTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 NORTH FREEWAY BLVD SUITE 105
SACRAMENTO CA
95834
US

IV. Provider business mailing address

4420 DUCKHORN DR 200
SACRAMENTO CA
95834-2590
US

V. Phone/Fax

Practice location:
  • Phone: 916-993-8535
  • Fax: 916-285-5274
Mailing address:
  • Phone: 916-419-9900
  • Fax: 916-419-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA80226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: