Healthcare Provider Details

I. General information

NPI: 1225126600
Provider Name (Legal Business Name): ANITHA RAJAMANICKAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 WARING RD STE 3
OCEANSIDE CA
92056-4454
US

IV. Provider business mailing address

3907 WARING RD STE 3
OCEANSIDE CA
92056-4454
US

V. Phone/Fax

Practice location:
  • Phone: 917-297-4634
  • Fax: 760-450-9655
Mailing address:
  • Phone: 917-297-4634
  • Fax: 760-450-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35086070
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number137462
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036113007
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: