Healthcare Provider Details

I. General information

NPI: 1639268139
Provider Name (Legal Business Name): RAJESH J KADAKIA M D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 949-492-4994
  • Fax: 949-492-8517
Mailing address:
  • Phone: 949-492-4994
  • Fax: 949-492-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJESH J KADAKIA
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 949-492-4994