Provider Demographics
NPI:1821033622
Name:IYENGAR, GEETA VARADRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETA
Middle Name:VARADRAJ
Last Name:IYENGAR
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 31399
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0399
Mailing Address - Country:US
Mailing Address - Phone:626-457-5842
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:LL, STE 1600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1032022085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00348315OtherRAIL ROAD MEDICARE
CA000F52200OtherBLUE SHIELD
CA000F52200Medicaid
CAWF5220CMedicare PIN
CAP00348315OtherRAIL ROAD MEDICARE
CAI28263Medicare UPIN
CAWF5220DMedicare PIN
CAWF5220AMedicare PIN