Provider Demographics
NPI:1386997583
Name:BHUTIA, AZEB B (PHD)
Entity type:Individual
Prefix:DR
First Name:AZEB
Middle Name:B
Last Name:BHUTIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AZEB
Other - Middle Name:
Other - Last Name:BEKELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2513
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-2513
Mailing Address - Country:US
Mailing Address - Phone:213-713-2113
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 131
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3820
Practice Address - Country:US
Practice Address - Phone:213-713-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty