Provider Demographics
NPI:1881215952
Name:OFFICIUM VUTHOORI MD PLLC
Entity Type:Organization
Organization Name:OFFICIUM VUTHOORI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:861 CORONADO CENTER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3992
Mailing Address - Country:US
Mailing Address - Phone:702-407-8241
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:375 N STEPHANIE ST STE 1011
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8901
Practice Address - Country:US
Practice Address - Phone:702-407-8241
Practice Address - Fax:702-492-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty