Healthcare Provider Details

I. General information

NPI: 1174008148
Provider Name (Legal Business Name): PRITHVIRAJ DHARMARAJA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41301 12TH ST W STE A
PALMDALE CA
93551-1465
US

IV. Provider business mailing address

PO BOX 6168
LANCASTER CA
93539-6168
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-6277
  • Fax: 661-726-6291
Mailing address:
  • Phone: 661-726-6277
  • Fax: 661-726-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRITHVIRAJ DHARMARAJA
Title or Position: CEO
Credential: MD
Phone: 661-726-6277