Provider Demographics
NPI:1033388616
Name:RAO, SOUMYA G (MD)
Entity Type:Individual
Prefix:
First Name:SOUMYA
Middle Name:G
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15611 POMERADO RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-675-3150
Mailing Address - Fax:858-613-2941
Practice Address - Street 1:15611 POMERADO RD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-675-3150
Practice Address - Fax:858-613-2941
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99911207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADJ372ZMedicare PIN
CADJ372YMedicare PIN