=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114949104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARSHANA RAJESH KADAKIA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 12/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 S EL CAMINO REAL SUITE A
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-492-4994
-----------------------------------------------------
Fax | 949-492-8517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 S EL CAMINO REAL SUITE A
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-492-4994
-----------------------------------------------------
Fax | 949-492-8517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | A41856
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | A41856
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | A41856
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------