Provider Demographics
NPI:1326340282
Name:INDERMOHAN S LUTHRA MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:INDERMOHAN S LUTHRA MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:INDERMOHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-328-7500
Mailing Address - Street 1:35400 BOB HOPE DR
Mailing Address - Street 2:STE 206
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1772
Mailing Address - Country:US
Mailing Address - Phone:760-328-7500
Mailing Address - Fax:760-328-0044
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:STE 206
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1772
Practice Address - Country:US
Practice Address - Phone:760-328-7500
Practice Address - Fax:760-328-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A505640174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505640Medicaid
CA00A505640Medicaid
CA00A505640Medicare PIN