Provider Demographics
NPI:1730112731
Name:SWAMIDURAI, RAJESHWARY (MD)
Entity Type:Individual
Prefix:MS
First Name:RAJESHWARY
Middle Name:
Last Name:SWAMIDURAI
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:465 W PUTNAM
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-784-1110
Practice Address - Fax:559-791-4733
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84859207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A848590OtherBLUE SHIELD OF CALIFORNIA
CAP01597186OtherRR PTAN
CA00A848590Medicaid
CAI55200Medicare UPIN
CABR705WMedicare PIN
CA00A848590Medicare PIN