Provider Demographics
NPI:1063542140
Name:NALLAMOTHU, BHUVANESWARI (MD)
Entity type:Individual
Prefix:DR
First Name:BHUVANESWARI
Middle Name:
Last Name:NALLAMOTHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28125 BRADLEY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2288
Mailing Address - Country:US
Mailing Address - Phone:951-309-2140
Mailing Address - Fax:951-309-2141
Practice Address - Street 1:28125 BRADLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2288
Practice Address - Country:US
Practice Address - Phone:951-309-2140
Practice Address - Fax:951-309-2141
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA898522084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89852OtherMEDICAL BOARD OF CALIFORNIA LICENSE