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General NPI Number Information
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NPI Number | 1851044366
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Entity Type | Organization
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Legal Business Name | MUKESH BHOGILAL SUTHAR MD INC
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 965 S E ST STE E
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1940
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Country | US
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Telephone | 909-889-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 10808 FOOTHILL BLVD STE 160-203
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3889
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Country | US
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Telephone | 909-889-5669
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MUKESH B. SUTHAR
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Credential | MD
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Telephone | 909-660-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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