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General NPI Number Information
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NPI Number | 1861792558
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Entity Type | Organization
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Legal Business Name | RAVEENDRA NADARAJA, M.D., F.A.C.S., INC.
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 20055 LAKE CHABOT RD STE 330
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5334
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Country | US
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Telephone | 510-538-2146
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Fax | 510-538-7959
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Provider Business Mailing Address
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Address Line | 20055 LAKE CHABOT RD STE 330
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5334
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Country | US
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Telephone | 510-538-2146
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Fax | 510-538-7959
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Authorized Official
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Title or Position | MANAGER
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Name | DR. GOWRI NADARAJA
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Credential |
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Telephone | 510-538-2146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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