Provider Demographics
NPI:1629128285
Name:RAJENDRA K. TIWARI, M.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RAJENDRA K. TIWARI, M.D., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-5117
Mailing Address - Street 1:1500 S CENTRAL AVE
Mailing Address - Street 2:#314
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2573
Mailing Address - Country:US
Mailing Address - Phone:818-244-5117
Mailing Address - Fax:818-244-6957
Practice Address - Street 1:1500 S CENTRAL AVE
Practice Address - Street 2:#314
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2573
Practice Address - Country:US
Practice Address - Phone:818-244-5117
Practice Address - Fax:818-244-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26099207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260990Medicaid
CA00A260990Medicaid
CAA26099Medicare PIN