Provider Demographics
NPI:1437168531
Name:VARUGHESE, BIJU (MD)
Entity Type:Individual
Prefix:
First Name:BIJU
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90139556OtherPACIFICARE
CA7994807OtherCIGNA
CA102614OtherHEALTH NET
CA2358917OtherUNITED HEALTHCARE
CA7506511OtherAETNA
CA98256OtherINTERPLAN
CAA83343OtherBLUE CROSS
CAMCMG270300OtherWESTERN HEALTH ADVANTAGE
CA000810568677OtherPHCS
CA1710757OtherGREAT WEST
CA2130920OtherFIRST HEALTH
CA102614OtherHEALTH NET
H95734Medicare UPIN