Provider Demographics
NPI:1174255772
Name:RAJEEV RAO MD INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAJEEV RAO MD INC A MEDICAL CORPORATION
Other - Org Name:RAJEEV RAO MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-332-2791
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0400
Mailing Address - Country:US
Mailing Address - Phone:424-431-4198
Mailing Address - Fax:
Practice Address - Street 1:8436 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4163
Practice Address - Country:US
Practice Address - Phone:310-274-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty