Provider Demographics
NPI:1265528111
Name:PATHAK, RAJIV J (MD)
Entity type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:J
Last Name:PATHAK
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 1:32585 GOLDEN LANTERN ST STE E
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3252
Mailing Address - Country:US
Mailing Address - Phone:949-240-2555
Mailing Address - Fax:949-240-2121
Practice Address - Street 1:32585 GOLDEN LANTERN ST STE E
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3252
Practice Address - Country:US
Practice Address - Phone:949-240-2555
Practice Address - Fax:949-240-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59128207R00000X
CAC143677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF72006Medicare UPIN
NJ755549Medicare ID - Type Unspecified