Provider Demographics
NPI:1295025591
Name:DIANAND RAJIGADOO
Entity Type:Organization
Organization Name:DIANAND RAJIGADOO
Other - Org Name:D RAJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJIGADOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-321-2705
Mailing Address - Street 1:1020 CHELSEA PARC DR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8160
Mailing Address - Country:US
Mailing Address - Phone:352-321-2705
Mailing Address - Fax:352-394-4005
Practice Address - Street 1:1020 CHELSEA PARC DR
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-8160
Practice Address - Country:US
Practice Address - Phone:352-321-2705
Practice Address - Fax:352-394-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002552900Medicaid