Provider Demographics
NPI:1174008148
Name:PRITHVIRAJ DHARMARAJA, MD, INC.
Entity Type:Organization
Organization Name:PRITHVIRAJ DHARMARAJA, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRITHVIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARMARAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-726-6277
Mailing Address - Street 1:PO BOX 6168
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-6168
Mailing Address - Country:US
Mailing Address - Phone:661-726-6277
Mailing Address - Fax:661-726-6291
Practice Address - Street 1:41301 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1465
Practice Address - Country:US
Practice Address - Phone:661-726-6277
Practice Address - Fax:661-726-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932111424Medicaid