Provider Demographics
NPI:1922044833
Name:RAJARATNAM, RUPERT J (MD)
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:J
Last Name:RAJARATNAM
Suffix:
Gender:M
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 1750
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-1750
Mailing Address - Country:US
Mailing Address - Phone:661-942-0101
Mailing Address - Fax:661-723-5031
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:661-940-1346
Practice Address - Fax:661-940-1362
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836750OtherBLUE SHIELD
CA00A836750Medicaid
CAP00238722OtherRAILROAD MEDICARE
CAP00238722OtherRAILROAD MEDICARE
CA00A836750Medicaid
CABY885YMedicare PIN