MEDICARE: TINA BHUTANI-JACQUES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A108915	CA

General Provider Information

NPI Number	:	1144483124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA BHUTANI-JACQUES MD

Provider Business Mailing Address
First Line	:	595 BUCKINGHAM WAY STE 220
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-1910
Country	:	US
Telephone Number	:	714-235-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 BUCKINGHAM WAY STE 220
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-1910
Country	:	US
Telephone Number	:	415-333-0348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	02/12/2024

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