MEDICARE: DR. RAGAVI ELANGOVAN D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A14118	CA

General Provider Information

NPI Number	:	1336587658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGAVI ELANGOVAN D.O

Provider Business Mailing Address
First Line	:	3390 HARBOR BLVD STE 100
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1554
Country	:	US
Telephone Number	:	562-237-6417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 HARBOR BLVD STE 100
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1554
Country	:	US
Telephone Number	:	562-237-6417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2013
Last Update Date	:	08/02/2022

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