Healthcare Provider Details

I. General information

NPI: 1003466590
Provider Name (Legal Business Name): VUTHOORI MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 S MARYLAND PKWY STE 202
LAS VEGAS NV
89109-6227
US

IV. Provider business mailing address

3061 S MARYLAND PKWY STE 202
LAS VEGAS NV
89109-6227
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 TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SRINIVAS VUTHOORI
Title or Position: PRESIDENT
Credential: MD
Phone: 760-972-6060