Provider Demographics
NPI:1346402286
Name:NAGARAJ, GAYATHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:
Last Name:NAGARAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 CAMPUS ST
Mailing Address - Street 2:CSP 11015
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1700
Mailing Address - Country:US
Mailing Address - Phone:909-558-4910
Mailing Address - Fax:909-558-0219
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:SCHUMAN PAVILION, ROOM A600
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-2262
Practice Address - Fax:909-651-5939
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102282207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology