Provider Demographics
NPI:1881790418
Name:BHUPATHY, ANAND RAJA (DO)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:RAJA
Last Name:BHUPATHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ANAND
Other - Middle Name:RAJA
Other - Last Name:BHUPATHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:21634 RETREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21634 RETREAT PKWY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6100
Practice Address - Country:US
Practice Address - Phone:951-782-3818
Practice Address - Fax:951-826-8128
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6177OtherLICENCE
CABB3571571OtherDEA
CAG10938Medicare UPIN