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General NPI Number Information
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NPI Number | 1972315919
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Entity Type | Organization
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Legal Business Name | RETINA GLOBAL
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 801 N TUSTIN AVE STE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-3600
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Country | US
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Telephone | 714-494-4085
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8012
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City | LAGUNA HILLS
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State | CA
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Zip | 92654-8012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | RAJAT AGRAWAL
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Credential |
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Telephone | 626-818-9697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology 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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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