Healthcare Provider Details

I. General information

NPI: 1063035954
Provider Name (Legal Business Name): JASON SCOTT HUTZLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STOCKTON BLVD NAOB 5TH FLOOR
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2335 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number203650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: