Provider Demographics
NPI:1073514261
Name:VIGNARAJAN, NIRUPA (MD)
Entity Type:Individual
Prefix:
First Name:NIRUPA
Middle Name:
Last Name:VIGNARAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-553-6666
Mailing Address - Fax:818-553-6651
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-553-6666
Practice Address - Fax:818-553-6651
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541070OtherMEDI-CAL PROVIDER NUMBER
CA00A541070OtherMEDI-CAL PROVIDER NUMBER
CAA54107Medicare ID - Type Unspecified