Provider Demographics
NPI:1326047309
Name:TIWARI, BHOODEV (MD)
Entity Type:Individual
Prefix:
First Name:BHOODEV
Middle Name:
Last Name:TIWARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27830 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2201
Mailing Address - Country:US
Mailing Address - Phone:951-672-3888
Mailing Address - Fax:951-672-3758
Practice Address - Street 1:27830 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2201
Practice Address - Country:US
Practice Address - Phone:951-672-3888
Practice Address - Fax:951-672-3758
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-01-21
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CAA49209207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A492090Medicaid
CA1326047309OtherNPI
CAA49209OtherLICENSE
CA00A492090Medicaid
CAA49209OtherLICENSE