Healthcare Provider Details

I. General information

NPI: 1811213564
Provider Name (Legal Business Name): RAINA M FERZOCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAINA MAHAJAN MD

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 NATIONAL AVE STE 201
LOS GATOS CA
95032-2433
US

IV. Provider business mailing address

15400 NATIONAL AVE STE 201
LOS GATOS CA
95032-2433
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-8415
  • Fax: 408-502-9740
Mailing address:
  • Phone: 408-358-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA159773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: