Healthcare Provider Details

I. General information

NPI: 1144474685
Provider Name (Legal Business Name): KUTHURU DESERT PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W CHARLESTON BLVD SUITE 207
LAS VEGAS NV
89146-1217
US

IV. Provider business mailing address

5701 W CHARLESTON BLVD SUITE 207
LAS VEGAS NV
89146-1217
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-8318
  • Fax: 702-240-8331
Mailing address:
  • Phone: 702-240-8318
  • Fax: 702-240-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1201
License Number StateNV

VIII. Authorized Official

Name: MAHESH REDDY KUTHURU
Title or Position: PRESIDENT
Credential: MD
Phone: 702-371-6173