Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | C50075 | CA |
NPI | 1275588733 |
---|---|
Provider Name | Dr. Rajiv Puri |
First Address | Victorville, CA 92395-7788 |
Second Address | Victorville, CA 92395-7788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 20/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C500750 | (05) | CA |
A62195 | (02) | CA |