Provider Demographics
NPI:1639449960
Name:DAMODARA RAJASEKHAR, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAMODARA RAJASEKHAR, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMODARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJASEKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-3004
Mailing Address - Street 1:18182 OUTER HIGHWAY 18 STE 103
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2200
Mailing Address - Country:US
Mailing Address - Phone:760-242-3004
Mailing Address - Fax:760-242-3009
Practice Address - Street 1:18182 OUTER HIGHWAY 18 STE 103
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2200
Practice Address - Country:US
Practice Address - Phone:760-242-3004
Practice Address - Fax:760-242-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care