Provider Demographics
NPI:1689669962
Name:IYER, RAJINI (MD)
Entity Type:Individual
Prefix:
First Name:RAJINI
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3401
Mailing Address - Country:US
Mailing Address - Phone:951-279-8600
Mailing Address - Fax:951-279-5489
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3401
Practice Address - Country:US
Practice Address - Phone:951-279-8600
Practice Address - Fax:951-279-5489
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41811207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A418110Medicaid
CA00A418110Medicare ID - Type Unspecified
CA00A418110Medicaid