Healthcare Provider Details

I. General information

NPI: 1407975501
Provider Name (Legal Business Name): RAJESH KADAKIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S EL CAMINO REAL STE A
SAN CLEMENTE CA
92672-4279
US

IV. Provider business mailing address

910 S EL CAMINO REAL STE A
SAN CLEMENTE CA
92672-4279
US

V. Phone/Fax

Practice location:
  • Phone: 949-492-4994
  • Fax:
Mailing address:
  • Phone: 949-492-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA41855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: