Provider Demographics
NPI:1134348014
Name:RAJYAGURU, VRAJLAL L (MD)
Entity type:Individual
Prefix:DR
First Name:VRAJLAL
Middle Name:L
Last Name:RAJYAGURU
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 1:505 W VINE ST # 301
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4156
Mailing Address - Country:US
Mailing Address - Phone:407-935-9404
Mailing Address - Fax:407-935-9304
Practice Address - Street 1:505 W VINE ST # 301
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4156
Practice Address - Country:US
Practice Address - Phone:407-935-9404
Practice Address - Fax:407-935-9304
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066759207L00000X
FLME66759207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377046000Medicaid
FL593339956OtherTAX IID#
FL26492AMedicare PIN
FL26493ZMedicare PIN
FL593339956OtherTAX IID#
FL26492BMedicare PIN