MEDICARE: SRINIVAS BHAWANI VUTHOORI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	C54634	CA
2	207R00000X	Internal Medicine Physician	C54634	CA
3	207R00000X	Internal Medicine Physician	10013	NV

General Provider Information

NPI Number	:	1235183278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVAS BHAWANI VUTHOORI M.D.

Provider Business Mailing Address
First Line	:	35280 BOB HOPE DR STE 100
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1753
Country	:	US
Telephone Number	:	760-660-4790
Fax Number	:	866-554-1794

Provider Business Practice Location Address
First Line	:	604 E HOBSONWAY
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1739
Country	:	US
Telephone Number	:	760-660-4790
Fax Number	:	866-554-1794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	09/01/2022

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