Healthcare Provider Details

I. General information

NPI: 1962580795
Provider Name (Legal Business Name): RAJEEV VERMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN STE 1300
FRESNO CA
93701-2124
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 866-342-6012
  • Fax:
Mailing address:
  • Phone: 559-443-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: