Provider Demographics
NPI:1134102007
Name:RAJADHYAKSHA, SADASHIV (MD)
Entity Type:Individual
Prefix:
First Name:SADASHIV
Middle Name:
Last Name:RAJADHYAKSHA
Suffix:
Gender:M
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:PO BOX 4166
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-4166
Mailing Address - Country:US
Mailing Address - Phone:714-899-4005
Mailing Address - Fax:714-899-4275
Practice Address - Street 1:21520 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 410G
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3762
Practice Address - Country:US
Practice Address - Phone:714-899-4005
Practice Address - Fax:714-899-4275
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28117Medicare UPIN
CAA36544Medicare ID - Type Unspecified