Healthcare Provider Details

I. General information

NPI: 1881856458
Provider Name (Legal Business Name): CHITTA THIAGARAJAH MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 N 10TH ST W STE110
LANCASTER CA
93534-3033
US

IV. Provider business mailing address

PO BOX 2858
LANCASTER CA
93539-2858
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-9966
  • Fax: 661-949-9926
Mailing address:
  • Phone: 661-729-6854
  • Fax: 661-729-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY J CARA
Title or Position: BILLER
Credential:
Phone: 661-729-6854