Healthcare Provider Details

I. General information

NPI: 1134102007
Provider Name (Legal Business Name): SADASHIV RAJADHYAKSHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 YORBA LINDA BLVD SUITE 410G
YORBA LINDA CA
92887-3762
US

IV. Provider business mailing address

PO BOX 4166
HUNTINGTON BEACH CA
92605-4166
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-4005
  • Fax: 714-899-4275
Mailing address:
  • Phone: 714-899-4005
  • Fax: 714-899-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA36544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: