Healthcare Provider Details

I. General information

NPI: 1265448112
Provider Name (Legal Business Name): RADHA IYENGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MADISON ST
CARLSBAD CA
92008-2310
US

IV. Provider business mailing address

3050 MADISON ST
CARLSBAD CA
92008-2310
US

V. Phone/Fax

Practice location:
  • Phone: 760-720-7766
  • Fax: 760-720-7204
Mailing address:
  • Phone: 760-720-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: