Provider Demographics
NPI:1770591463
Name:PARESH K RAJAJOSHIWALA MD FACS PA
Entity type:Organization
Organization Name:PARESH K RAJAJOSHIWALA MD FACS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAJAJOSHIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-324-5726
Mailing Address - Street 1:22 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1019
Mailing Address - Country:US
Mailing Address - Phone:210-324-5726
Mailing Address - Fax:210-579-0705
Practice Address - Street 1:18518 HARDY OAK BLVD
Practice Address - Street 2:STE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4759
Practice Address - Country:US
Practice Address - Phone:210-579-0747
Practice Address - Fax:210-579-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179251701Medicaid
TX179252501Medicaid
TX0071NLOtherGROUP NUMBER BCBS
TX8V4110OtherINDIVIDUAL NUMBER BCBS
TX8V4110OtherINDIVIDUAL NUMBER BCBS
00W342Medicare ID - Type UnspecifiedGROUP NUMBER
TX179251701Medicaid