Provider Demographics
NPI:1790969616
Name:VIJAYARAGHAVAN, MAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:VIJAYARAGHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:BOX 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102
Mailing Address - Country:US
Mailing Address - Phone:619-906-4623
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:1809 NATIONAL AVENUE
Practice Address - Street 2:6TH FLOOR, CTR12
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113
Practice Address - Country:US
Practice Address - Phone:619-906-4623
Practice Address - Fax:619-906-4564
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine