Provider Demographics
NPI:1093966236
Name:GAGNEJA, RITOO (MD)
Entity Type:Individual
Prefix:DR
First Name:RITOO
Middle Name:
Last Name:GAGNEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-727-1515
Mailing Address - Fax:818-727-7997
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-727-1515
Practice Address - Fax:818-727-7997
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ288XMedicare PIN