Provider Demographics
NPI:1760553903
Name:VIRARAGHAVAN, ROOPA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOPA
Middle Name:
Last Name:VIRARAGHAVAN
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 1:16402 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1931
Mailing Address - Country:US
Mailing Address - Phone:562-926-9310
Mailing Address - Fax:208-275-5040
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8017
Practice Address - Fax:714-834-7956
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG855502080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G855500Medicaid
CA00G855500Medicaid