Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A78175 | CA |
N | 111NI0900X | Internist | A78175 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | A78175 | CA |
NPI | 1396814356 |
---|---|
Provider Name | Sangeetha Raghuraman |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H886967 | (02) | CA |