Healthcare Provider Details

I. General information

NPI: 1760553903
Provider Name (Legal Business Name): ROOPA VIRARAGHAVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

16402 REDWOOD DR
CERRITOS CA
90703-1931
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8017
  • Fax: 714-834-7956
Mailing address:
  • Phone: 562-926-9310
  • Fax: 208-275-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberG85550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: