Healthcare Provider Details

I. General information

NPI: 1255379301
Provider Name (Legal Business Name): PADMINI VARADARAJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

IV. Provider business mailing address

1752 E LUGONIA AVE STE 117-1124
REDLANDS CA
92374-2730
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-5500
  • Fax:
Mailing address:
  • Phone: 909-496-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA67664
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number67664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: