Doctor Name: | MR. SIBU RAJAN |
NPI Number: | 1114112596 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA 19141 |
Business Practice Address: | 16907 Devonshire St Granada Hills, CA - 913447407 |
Business Phone Number: | 8183664626 |
Business Fax Number: | 8183664630 |
Mailing Address: | 16907 Devonshire St, GRANADA HILLS |
State: | CA |
Postal Code: | 913447407 |
Phone Number: | 8183664626 |
Fax Number: | 8183664630 |
NPI Enumeration Date: | 09/10/2007 |
NPI Last Update Date: | 09/10/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA 19141 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |