Healthcare Provider Details

I. General information

NPI: 1184820995
Provider Name (Legal Business Name): RAMU THIAGARAJAN MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 NORTH PEARSON DR.
PORTERVILLE CA
93257-3368
US

IV. Provider business mailing address

382 NORTH PEARSON DR.
PORTERVILLE CA
93257-3368
US

V. Phone/Fax

Practice location:
  • Phone: 559-783-0100
  • Fax: 559-783-0200
Mailing address:
  • Phone: 559-783-0100
  • Fax: 559-783-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA95502
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA95502
License Number StateCA

VIII. Authorized Official

Name: DR. RAMU THIAGARAJAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-783-0100