Individual
SUJAY DUTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2220 LYNN RD, SUITE 301, THOUSAND OAKS, CA 91360
(805) 495-1073
(805) 495-5836
Mailing address
2220 LYNN RD, SUITE 301, THOUSAND OAKS, CA 91360
(805) 495-1073
(805) 495-5836
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G85674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G856740
—
CA
Enumeration date
10/11/2006
Last updated
03/17/2008
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