Healthcare Provider Details

I. General information

NPI: 1104297803
Provider Name (Legal Business Name): RANI SAIJU JOHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONTINENTAL BLVD STE 635
EL SEGUNDO CA
90245-5040
US

IV. Provider business mailing address

13302 BRASS RING LN
CORONA CA
92880-3490
US

V. Phone/Fax

Practice location:
  • Phone: 562-335-2730
  • Fax:
Mailing address:
  • Phone: 480-294-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: