Provider Demographics
NPI:1669427514
Name:ANANDA, RAJESWARI (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESWARI
Middle Name:
Last Name:ANANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJEE
Other - Middle Name:
Other - Last Name:ANANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1550
Practice Address - Country:US
Practice Address - Phone:805-522-2900
Practice Address - Fax:805-522-8127
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA318972084N0400X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318970Medicaid
CA00A318970Medicaid
CAA26635Medicare UPIN