Healthcare Provider Details

I. General information

NPI: 1235183278
Provider Name (Legal Business Name): SRINIVAS BHAWANI VUTHOORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SRINIVAS B VUTHOORI M.D.

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E HOBSONWAY
BLYTHE CA
92225-1739
US

IV. Provider business mailing address

35280 BOB HOPE DR STE 100
RANCHO MIRAGE CA
92270-1753
US

V. Phone/Fax

Practice location:
  • Phone: 760-660-4790
  • Fax: 866-554-1794
Mailing address:
  • Phone: 760-660-4790
  • Fax: 866-554-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC54634
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC54634
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10013
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: