Healthcare Provider Details

I. General information

NPI: 1023766375
Provider Name (Legal Business Name): RAJIV SIDDHARTHA VASUDEVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE
LA JOLLA CA
92093-0001
US

IV. Provider business mailing address

UNIVERSITY OF CALIFORNIA SAN DIEGO SCHOOL OF MEDICINE
LA JOLLA CA
92093-1329
US

V. Phone/Fax

Practice location:
  • Phone: 650-714-7908
  • Fax:
Mailing address:
  • Phone: 650-714-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: