Healthcare Provider Details

I. General information

NPI: 1366930661
Provider Name (Legal Business Name): PAVANDEEP RAKHRA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-7984
  • Fax: 855-246-2329
Mailing address:
  • Phone: 714-509-7984
  • Fax: 855-246-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number20A24123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: