Healthcare Provider Details

I. General information

NPI: 1093795684
Provider Name (Legal Business Name): AJANTA NAIDU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCI MEDICAL CENTER 101 THE CITY DRIVE, PAVILLION 1
ORANGE CA
92868
US

IV. Provider business mailing address

26 HEADLAND DR
RANCHO PALOS VERDES CA
90275-5117
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7011
  • Fax: 714-456-7857
Mailing address:
  • Phone: 310-989-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA41593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: