Provider Demographics
NPI:1740731413
Name:BHOOT, HEETEN VASUDEV (DO)
Entity type:Individual
Prefix:DR
First Name:HEETEN
Middle Name:VASUDEV
Last Name:BHOOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:1901 TOWN AND COUNTRY DR STE 102
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3611
Practice Address - Country:US
Practice Address - Phone:951-736-8100
Practice Address - Fax:951-736-8787
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A15217207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA422262Medicaid