Healthcare Provider Details

I. General information

NPI: 1932425782
Provider Name (Legal Business Name): SOORAJ TEJASWI M.D., M.S.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MEDICAL PKWY STE 200
CEDAR PARK TX
78613-2778
US

IV. Provider business mailing address

213 SELBY RANCH RD UNIT 1
SACRAMENTO CA
95864-5822
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-0900
  • Fax: 512-341-2895
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA111161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: