Provider Demographics
NPI:1104101948
Name:SRINIVAS B VUTHOORI MD, A PROFESSIONAL CORPORATION, CAMBRIDGE HOSPITAL
Entity type:Organization
Organization Name:SRINIVAS B VUTHOORI MD, A PROFESSIONAL CORPORATION, CAMBRIDGE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:VUTHOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-833-7977
Mailing Address - Street 1:35400 BOB HOPE DR
Mailing Address - Street 2:#102
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1772
Mailing Address - Country:US
Mailing Address - Phone:760-833-7977
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:#102
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1772
Practice Address - Country:US
Practice Address - Phone:760-972-6060
Practice Address - Fax:702-492-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP523AMedicare PIN