Provider Demographics
NPI:1043410764
Name:UJWALA RAJGOPAL, MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:UJWALA RAJGOPAL, MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UJWALA
Authorized Official - Middle Name:DESHMANE
Authorized Official - Last Name:RAJGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-774-0719
Mailing Address - Street 1:12435 RAGWEED ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4161
Mailing Address - Country:US
Mailing Address - Phone:858-484-8557
Mailing Address - Fax:858-484-8557
Practice Address - Street 1:320 SANTA FE DR STE 300
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5140
Practice Address - Country:US
Practice Address - Phone:760-753-5667
Practice Address - Fax:760-753-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56387208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH33475Medicare UPIN