Provider Demographics
NPI:1154409290
Name:BHASKER-RAO, BOBBY SULIN (MD)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:SULIN
Last Name:BHASKER-RAO
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 1:35900 BOB HOPE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1766
Mailing Address - Country:US
Mailing Address - Phone:760-778-5220
Mailing Address - Fax:760-778-5221
Practice Address - Street 1:35900 BOB HOPE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1766
Practice Address - Country:US
Practice Address - Phone:760-778-5220
Practice Address - Fax:760-778-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76846208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH55576Medicare UPIN
CA00A768460Medicare ID - Type Unspecified