Provider Demographics
NPI:1619552205
Name:VUTHOORI MD
Entity Type:Organization
Organization Name:VUTHOORI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:VUTHOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-407-8241
Mailing Address - Street 1:35280 BOB HOPE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1753
Mailing Address - Country:US
Mailing Address - Phone:702-407-8241
Mailing Address - Fax:
Practice Address - Street 1:35280 BOB HOPE DR STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1753
Practice Address - Country:US
Practice Address - Phone:702-407-8241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty