Provider Demographics
NPI:1467656181
Name:PANGULURI, RAJEEV LOCHAN (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:LOCHAN
Last Name:PANGULURI
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 1:15297 CAYENNE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3717
Mailing Address - Country:US
Mailing Address - Phone:601-942-8419
Mailing Address - Fax:
Practice Address - Street 1:624 E ELDER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3004
Practice Address - Country:US
Practice Address - Phone:760-451-4165
Practice Address - Fax:858-221-8554
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1488632084P0800X
MS198902084P0800X
IL036.1271612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry