Provider Demographics
NPI:1396293684
Name:BHUTIA, TASHI PALDON (PT)
Entity type:Individual
Prefix:
First Name:TASHI
Middle Name:PALDON
Last Name:BHUTIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TASHI
Other - Middle Name:PALDON
Other - Last Name:HONANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7525 METROPOLITAN DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4404
Mailing Address - Country:US
Mailing Address - Phone:619-432-4634
Mailing Address - Fax:866-813-1235
Practice Address - Street 1:2700 N MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6638
Practice Address - Country:US
Practice Address - Phone:844-316-7979
Practice Address - Fax:866-813-1235
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62 040836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA299014OtherCOMMERCIAL, PPO, PRIVATE