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General NPI Number Information
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NPI Number | 1497974091
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Entity Type | Organization
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Legal Business Name | INDU RAGHAVAN MD INC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 516 PENNSFIELD PL SUITE 105
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City | THOUSAND OAKS
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State | CA
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Zip | 91360
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Country | US
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Telephone | 805-496-8003
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Fax | 805-496-8303
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Provider Business Mailing Address
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Address Line | 516 PENNSFIELD PL SUITE 105
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City | THOUSAND OAKS
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State | CA
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Zip | 91360
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Country | US
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Telephone | 805-496-8003
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Fax | 805-496-8303
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Authorized Official
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Title or Position | OWNER
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Name | INDU RAGHAVAN
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Credential | MD
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Telephone | 805-496-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | A054464
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License Number State | CA
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