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General NPI Number Information
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NPI Number | 1467462143
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Entity Type | Individual
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Provider Name | ZANDRA TUTT MD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 19351 LURIN AVE
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City | RIVERSIDE
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State | CA
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Zip | 92508-9608
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Country | US
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Telephone | 954-937-2944
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 E HALLANDALE BLVD 127
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City | HALLANDALE
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State | FL
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Zip | 33009
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Country | US
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Telephone | 305-416-7149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0062990
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A54432
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License Number State | CA
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