Healthcare Provider Details

I. General information

NPI: 1265528111
Provider Name (Legal Business Name): RAJIV J PATHAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24221 CALLE DE LA LOUISA STE 300
LAGUNA HILLS CA
92653-7637
US

IV. Provider business mailing address

32585 GOLDEN LANTERN STE E
DANA POINT CA
92629-3252
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-8700
  • Fax: 949-420-5977
Mailing address:
  • Phone: 949-240-2555
  • Fax: 949-240-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC143677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA59128
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: