Healthcare Provider Details

I. General information

NPI: 1881215952
Provider Name (Legal Business Name): OFFICIUM VUTHOORI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 1011
HENDERSON NV
89014-8901
US

IV. Provider business mailing address

861 CORONADO CENTER DR STE 211
HENDERSON NV
89052-3992
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-8241
  • Fax: 702-492-1728
Mailing address:
  • Phone: 702-407-8241
  • Fax: 702-492-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SRINIVAS B VUTHOORI
Title or Position: CEO
Credential: MD
Phone: 702-407-8241