Provider Demographics
NPI:1376723601
Name:RAJEE ANANDA, M.D., INC.
Entity Type:Organization
Organization Name:RAJEE ANANDA, M.D., INC.
Other - Org Name:RAJESWARI ANANDA, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-522-2900
Mailing Address - Street 1:2876 SYCAMORE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1530
Mailing Address - Country:US
Mailing Address - Phone:805-522-2900
Mailing Address - Fax:805-522-8127
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1530
Practice Address - Country:US
Practice Address - Phone:805-522-2900
Practice Address - Fax:805-522-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31897204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW985Medicare PIN