Provider Demographics
NPI:1285991968
Name:BHUTIA, TSHERING WANGMO (MD)
Entity type:Individual
Prefix:
First Name:TSHERING
Middle Name:WANGMO
Last Name:BHUTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CALIFORNIA DRIVE, DEPARTMENT OF CORRECTIONS & REHA
Mailing Address - Street 2:CALIFORNIA MEDICINE FAMILY, PSYCHIATRY, INPATIENT PROGR
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-448-6841
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DRIVE, DEPARTMENT OF CORRECTIONS & REHA
Practice Address - Street 2:CALIFORNIA MEDICINE FAMILY, PSYCHIATRY, INPATIENT PROGR
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-448-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1429132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program