Healthcare Provider Details

I. General information

NPI: 1750841193
Provider Name (Legal Business Name): RAAGAV MOHANAKRISHNAN DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

PO BOX 708
RODEO CA
94572-0708
US

V. Phone/Fax

Practice location:
  • Phone: 855-736-2789
  • Fax: 407-324-4727
Mailing address:
  • Phone: 877-346-2211
  • Fax: 407-324-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO210477
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A22310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: