Provider Demographics
NPI:1891757217
Name:TAJRAN, DEENA S (MD FACOG)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:S
Last Name:TAJRAN
Suffix:
Gender:F
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 VIA CASA ALTA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-578-9600
Mailing Address - Fax:858-578-9065
Practice Address - Street 1:10737 CAMINO RUIZ
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-578-9600
Practice Address - Fax:858-578-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55154207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65933ZOtherBLUE SHIELD OF CA
CA00A551540Medicaid
CAZZZ659312OtherBLUE SHIELD OF CA
CAZZZ65932ZOtherBLUE SHIELD OF CA
CA774581OtherAETNA
CA774581OtherAETNA
CAZZZ65933ZOtherBLUE SHIELD OF CA