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General NPI Number Information
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NPI Number | 1821819301
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Entity Type | Individual
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Provider Name | RENUKA RAJIV NP
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 949 PALM AVE
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-1503
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Country | US
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Telephone | 619-429-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 3RD AVE UNIT 105
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City | SAN DIEGO
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State | CA
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Zip | 92103-4126
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Country | US
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Telephone | 857-203-1905
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F02240409
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95031599
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License Number State | CA
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