Provider Demographics
NPI:1235569419
Name:INDRAJITH, ARASU
Entity Type:Individual
Prefix:MR
First Name:ARASU
Middle Name:
Last Name:INDRAJITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12366 CARMEL COUNTRY RD
Mailing Address - Street 2:UNIT 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4513
Mailing Address - Country:US
Mailing Address - Phone:734-649-2726
Mailing Address - Fax:
Practice Address - Street 1:12366 CARMEL COUNTRY RD
Practice Address - Street 2:UNIT 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4513
Practice Address - Country:US
Practice Address - Phone:734-649-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist