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General NPI Number Information
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NPI Number | 1427103522
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Entity Type | Individual
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Provider Name | SAMUEL JOHN N RAJARATNAM MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 16152 BEACH BLVD STE 200
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3869
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Country | US
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Telephone | 714-841-6772
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Fax | 714-841-6775
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Provider Business Mailing Address
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Address Line | 23509 RIDGE LINE RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3008
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Country | US
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Telephone | 714-553-4592
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Fax | 714-841-6775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A51207
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License Number State | CA
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