Healthcare Provider Details

I. General information

NPI: 1982725180
Provider Name (Legal Business Name): VIJAY RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VIJAY RAO PHOOSHKOORU MD

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 BUTTE ST
REDDING CA
96001-0828
US

IV. Provider business mailing address

963 BUTTE ST
REDDING CA
96001-0828
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-5900
  • Fax: 530-245-5909
Mailing address:
  • Phone: 530-245-5900
  • Fax: 530-245-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD228950
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number12270
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number10514
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: