Provider Demographics
NPI:1902907108
Name:DR. A.R. BHUPATHY, INC
Entity type:Organization
Organization Name:DR. A.R. BHUPATHY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:RAJA
Authorized Official - Last Name:BHUPATHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-524-9700
Mailing Address - Street 1:22400 BARTON RD # 21-198
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5030
Mailing Address - Country:US
Mailing Address - Phone:714-315-3633
Mailing Address - Fax:760-318-8103
Practice Address - Street 1:11326 MOUNTAIN VIEW AVE STE B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3817
Practice Address - Country:US
Practice Address - Phone:909-799-0029
Practice Address - Fax:760-318-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6177207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6177OtherLICENSE
CABB3571571OtherDEA
CAG10938Medicare UPIN
CABB3571571OtherDEA