Healthcare Provider Details

I. General information

NPI: 1700144680
Provider Name (Legal Business Name): SANJAY S RAO MD A MEDICAL CORPORATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR SHARP GROSSMONT HOSPITAL
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 511353
LOS ANGELES CA
90051-7908
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4800
  • Fax: 877-588-7226
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA92683
License Number StateCA

VIII. Authorized Official

Name: SANJAY S RAO
Title or Position: OWNER
Credential: MD
Phone: 619-740-4800