Provider Demographics
NPI:1639268139
Name:RAJESH J KADAKIA M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAJESH J KADAKIA M D A MEDICAL CORPORATION
Other - Org Name:SAN CLEMENTE MEDI CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-492-4994
Mailing Address - Street 1:910 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4279
Mailing Address - Country:US
Mailing Address - Phone:949-492-4994
Mailing Address - Fax:949-492-8517
Practice Address - Street 1:910 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4279
Practice Address - Country:US
Practice Address - Phone:949-492-4994
Practice Address - Fax:949-492-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E50885Medicare UPIN
CAW13445Medicare PIN