Healthcare Provider Details

I. General information

NPI: 1275622052
Provider Name (Legal Business Name): AMARDIP S. BHULLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 170
RIVERSIDE CA
92505-3390
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 170
RIVERSIDE CA
92505-3390
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-9204
  • Fax:
Mailing address:
  • Phone: 951-509-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC55208
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number193
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: