Provider Demographics
NPI:1558708578
Name:RATHORE, AWTAR KARAN (DO)
Entity type:Individual
Prefix:
First Name:AWTAR
Middle Name:KARAN
Last Name:RATHORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:ROOM 3055
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-5411
Mailing Address - Fax:661-862-7682
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:ROOM 3055
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-326-5411
Practice Address - Fax:661-862-7682
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01022043232084P0800X, 2084P0804X
CA20A148362084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry