Provider Demographics
NPI:1407924996
Name:SURENDER VUTHOORI MD INC
Entity Type:Organization
Organization Name:SURENDER VUTHOORI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTHOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-770-1632
Mailing Address - Street 1:35280 BOB HOPE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-770-1632
Mailing Address - Fax:760-346-2471
Practice Address - Street 1:35280 BOB HOPE DR
Practice Address - Street 2:STE 100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-770-1632
Practice Address - Fax:760-346-2471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURENDER VUTHOORI MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33804207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A338041Medicaid
CAZZZ91620ZOtherMEDICARE ID TYPE
CA913622300OtherMED FL MEDI CAL FLORIDA
CA756061629OtherMEDICARE RAIL ROAD
CA00A338040OtherBLUESHIELD
CA199003100OtherACSTA ACS DEPARTMENT OF LABOUR
CA199003100OtherUS LAB USDEPARTMENT OF LABOUR
CA199003100OtherACSTA ACS DEPARTMENT OF LABOUR