Provider Demographics
NPI:1508886920
Name:BUDDEN, RAJIV (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:BUDDEN
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 1:101 S 1ST ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1938
Mailing Address - Country:US
Mailing Address - Phone:818-845-6206
Mailing Address - Fax:818-845-9774
Practice Address - Street 1:1920 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3503
Practice Address - Country:US
Practice Address - Phone:805-306-8800
Practice Address - Fax:805-306-8818
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G846001OtherBLUE SHIELD
CA00G846000Medicaid
CAG84600OtherMEDICAL LICENSE
CAP00012198OtherRAILROAD MEDICARE
CAG84600Medicare PIN
CA00G846000Medicaid
CA00G846001OtherBLUE SHIELD
CACA402AMedicare PIN
CAWG84600CMedicare PIN
CAG84600OtherMEDICAL LICENSE