Provider Demographics
NPI:1669567426
Name:SUNDHARADAS, RENJIT ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:RENJIT
Middle Name:ALLEN
Last Name:SUNDHARADAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11454 RAEDENE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6131
Mailing Address - Country:US
Mailing Address - Phone:619-330-8771
Mailing Address - Fax:661-729-6864
Practice Address - Street 1:162 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE A50
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4300
Practice Address - Country:US
Practice Address - Phone:619-330-8771
Practice Address - Fax:619-330-8772
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA962402081P2900X, 208VP0014X
WI46558-0202081P2900X, 208VP0014X
AZ36182208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA96240AMedicare PIN