Provider Demographics
NPI:1780630434
Name:RANA, RAJENDRA T (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:T
Last Name:RANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3134
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-8134
Mailing Address - Country:US
Mailing Address - Phone:714-883-7777
Mailing Address - Fax:714-636-1782
Practice Address - Street 1:22812 VIA ORVIETO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3452
Practice Address - Country:US
Practice Address - Phone:714-883-7777
Practice Address - Fax:714-636-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A307000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307000Medicaid
CA00A307000Medicaid
CA00A30700Medicare ID - Type Unspecified