Provider Demographics
NPI:1235183278
Name:VUTHOORI, SRINIVAS BHAWANI (MD)
Entity type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:BHAWANI
Last Name:VUTHOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRINIVAS
Other - Middle Name:B
Other - Last Name:VUTHOORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:760-660-4790
Mailing Address - Fax:866-554-1794
Practice Address - Street 1:604 E HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1739
Practice Address - Country:US
Practice Address - Phone:760-660-4790
Practice Address - Fax:866-554-1794
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54634208M00000X, 207R00000X
NV10013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP523AMedicare PIN
NV36405Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
NV2018727Medicaid