Basic Information
| Provider Information | |||||||||
| NPI: | 1770514531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHARMARAJAN | ||||||||
| FirstName: | DEEPA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 MARINA BLVD | ||||||||
| Address2: | 6TH FLOOR, SUITE 600 | ||||||||
| City: | BRISBANE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155143577 | ||||||||
| FaxNumber: | 4155140702 | ||||||||
| Practice Location | |||||||||
| Address1: | 20325 N 51ST AVE | ||||||||
| Address2: | BUILDING 6, SUITE 142 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853085674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235874500 | ||||||||
| FaxNumber: | 6235874681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | C173834 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QG0300X | 35176 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.