Healthcare Provider Details

I. General information

NPI: 1114949104
Provider Name (Legal Business Name): DARSHANA RAJESH KADAKIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

910 S EL CAMINO REAL SUITE A
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 TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA41856
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA41856
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA41856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: