Provider Demographics
NPI:1639345705
Name:BHOOT, NILESH HARILAL (MD)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:HARILAL
Last Name:BHOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2520 HONOLULU AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1853
Mailing Address - Country:US
Mailing Address - Phone:818-476-5656
Mailing Address - Fax:818-248-0999
Practice Address - Street 1:2520 HONOLULU AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1853
Practice Address - Country:US
Practice Address - Phone:818-476-5656
Practice Address - Fax:818-248-0999
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9419340Medicaid